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e <br /> 7d <br /> Waste r1o. 4 8 <br /> Systems <br /> NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> Uftowt!Itic.f:m lsMIlUSTRIES <br /> 2,r�,....f-rtsgm •r.r+r-. �.,�-.•"':�.�.'.".r'.'.'.n..t t �arR'1} <br /> � a.SuJ.=:...s:m^S <br /> Generating Location --- <br /> Gooerator Name__-- --_-------..__�--- <br /> Address <br /> Address ---.- — <br /> f.cc .ir <br /> t. Phone No. .------- <br /> PIlune No L__�❑_❑—❑ -- ❑_-- _ — --� <br /> ��� I Containets Typo <br /> BrI Wasw Code _❑ ��- � `—' — — �� �uanli! Units No. T e D Drum <br /> -Girton <br /> Description of Waste — �— --..-- - <br /> 1 T -Truck <br /> L= ElP-Pounds <br /> EL= El Y-Yards <br /> ❑ 11O-Other <br /> EE= F1_ 40 CFR Part 2GO.t0 or any applicable <br /> I hereby certify that the above named material does ot cont-Rill <br /> squid applicable slate Saw, has been properly described, <br /> state law, is not a hazardous waste as defined by a stat regulations. <br /> classified and packaged, and is in proper condition for transportation according to app g <br /> signature �`�� Shipniom Date <br /> Truck No. —_ _. Phone No. <br /> r <br /> Transporter Name i l: r., . .i;: . <br /> Driver Name(Print) <br /> Address Vehicle License No./State <br /> Vehicle Certification <br /> I hereby certify that the above named material was picked up 1 hereby certify that the abn4v named material was delivered with- <br /> at the generator site listed above. out incidem to the destination listed below. <br /> ,� , /:. r /�� e � �, , �- "tel _______CT.LT_�.L❑ <br /> Driver Sirgnatwe / ,'/ �Shipment tato Driver Signaiure Dewory bate <br /> MOM <br /> '-_.�._...�w....,'..cw1 w :4 Mi s,�r ti?•..3>�Y.:.^r.= ..:.a„s.,�by"�3:' ° 7�-``,--�,�c•.. tsr�.l„y... �" <br /> Site Name •t f ': 1' Phone No. Ei-—ET, <br /> :{tF1'. ,:�t. l .. �Ci __. � .�'.�Ct'i.::iCC:r .� .•;sF�?'v <br /> Address _ <br /> .r <br /> I hereby certify that the above named material has been accepted and to the best of my knowledge the.fcreaoing is true and accurate. <br /> N-.1 luthmizedArrnl S+ naiuro -- >✓r r AeCei C08EBr <br /> PASS CODE <br /> a <br /> p;96 BF1260.720 <br /> f <br /> TnANSPORTER RETAIN <br />