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= ar s l <br /> 4 <br /> 3 qw <br /> A <br /> �'1 e�rll <br /> Waste lda.11 <br /> ' NON-HA <br /> �s�terms T'� NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> nROwr111;G FE11R1S 114DU`'TMESvs <br /> 'CJ�A'r'ngy`1t _r'a1'r ay .r.�S-� r.aye.��.i.':.!'�=�.L,ifV.�.a'....r <br /> a <br /> nF�. x-'.. �r�.a+4iir�i."d"sd .� 1.1J <br /> Generating Location <br /> Generator Name_—.-- ---- -- <br /> �, I Address - "F <br /> Address — <br /> . : i•._�4�i �.;... _`ei moi;f a... .r �.' _.— ---------___ ------ <br /> --- Phone No. -- <br /> Phony No. —� — T r o <br /> •r�_� `i <br /> Containers <br /> 1 t <br /> L3F1 Wade Cute QuantilV I in+is No. T C.Carton <br /> Description of waste _ — —, �;"1 <br /> p-Eiag <br /> r,.I, :C _ —t t Truck <br /> .,.-I'.'7:'..L t� I P Pounds <br /> I I I Y-Yards <br /> El El <br /> o ii <br /> able <br /> 1 hereby certify that the above named material does not contain free liquid as defined le y 40stake Jaw. has beenlpraperly de0 or any scribed <br /> state law, is not a hazardous waste as defined by 40 CFR Pk.-.rt 281 or any app <br /> classified and packaged, <br /> //and is in proper condition folrap6port tion according to applicable regulations. <br /> Shipment DaiIaSignattAe <br /> r rilur Authorized Agnpnztr�Namaggo <br /> gp <br /> Phone No. <br /> Truck No. 7� <br /> Driver Name(Prin `�— <br /> Transporter Name <br /> Address <br /> C• ";iii Vehicle License NodState <br /> •Lt, i_:...?:. a:z=. c',;a�.� Vehicle Certification <br /> I hereby cerlily that the above named material was picked up f hereby certify that the above named material was delivered with- <br /> out incident to the destination listed below. <br /> at the generator site listed above, <br /> F Cativory Dalo <br /> ��� = _ �.a Shipment Date �Oj4ar signatw4 <br /> i <br /> - pnv r Silnatuco <br /> 1 pan'4 ` 1 ?„ �.'. �aY,_ 1- pry~ . s v <br /> t'•, .I. `7i= C=l �Uaci Izinv.l. ;l Phone No. <br /> Site Name ` a X550 <br /> ;;jt!I lL`Lr:; V. GCJ IY.I.r Ial'vCL'CL'�4'r <br /> Address <br /> I hereby certify that the above named material has been accepted and to the best of my knowledger�a foregoing is and accurate. <br /> l , rtezei2t Date r <br /> _._ ------.- <br /> --.._. .... Signature <br /> Huuy 01 Author rad AGnnl - - / - <br /> PASS CODE — <br /> M260.720 <br /> 30.°6 <br /> TRANSPORTER RETAIN <br />