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x s� <br /> waste <br /> ' , S""S Tr, NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> S , <br /> l--t.'r3J NO <br /> fJr40V'!tjlrJG FERSt1S INDUSTftICS �����Y ,�. � . .#y��"' ��,.�•�t,�i .1'r� �x �� <br /> ..�+.Yi.—.1F".�1m'S.�-1-v,.'.4"rs <br /> ff ,h riTj <br /> Generating Location— -- <br /> Generator Name —.--.—�� n I•'s. ' _—.--- -- <br /> Address _tf'—y.i' <br /> Address <br /> - —L <br /> ter— -- rr��T <br /> s. Phone No. <br /> Phone Ma. j_J ��� ' �� � l� Containers Type <br /> n Lam— I T e n Drum <br /> E L� t�L�� Quantiles Un-1 =its No. C-Carton <br /> E3F 1 Vlaste Code Description of 4Vasta -- p-Bag <br /> _ T-Truck <br /> P Pounds <br /> r_.a`::V:;1=.i•'!i i.i tar.K.�.ijtC)Li.:UEE= Ej EJ y.Yar"e <br /> O•OS11er <br /> O = E] .---.�.— <br /> — <br /> applicable <br /> Part <br /> s defined by 40 CFR Part 261 or any applicable state law, has been properly described. <br /> I hereby certify that the above named material does not contain free liquid as defined)cab e regulations. <br /> ns been <br /> or any <br /> state law, is not a hazardous was <br /> ctassilied and packaged,andJ is in proper condition for t anspurtation according to a � f <br /> Shipment pate <br /> r Signdw, 1 <br /> G.icr st<rr tvlhurued A{]enl ralma : M615-634 <br /> � �- <br /> �.. <br /> Phone No. <br /> Truck No. <br /> r Driver Name(Prin <br /> Transporter Name <br /> Vehicle License No./State r <br /> Address r �a.� •—•-- <br /> Vehicle Certification <br /> I he certify that the above named material teas delivered with- <br /> out incident to the destination listed below. <br /> I hereby certify that the above named material was picked up / f <br /> enorator site listed above. } `/ <br /> at the 9 <br /> •....�'I ..� >� � / � / 4 of 'L%� f pe�iv67 <br /> nv�rrSiupStura <br /> 5hipmonl Data <br /> , <br /> Orr er S g7ztrru �' �` 1 l - MIM- <br /> .. '" . . gE'.'i� y <br /> � ¢ _ <br /> t <br /> '1�4F,ek K3 A r <br /> �^ Phone No. <br /> Site Name 5 /1 <br /> Address <br /> 1 hereby certify that she above named material has been accept�an�ito the best of my knowledge the foregoing is true and <br /> accurate, <br /> VIM <br /> -- --- - -- <br /> _- o.to <br /> ��_� 5r nature <br /> �;u„c el Authanzed F <br /> PASS CODE <br /> BFI2G6.720 <br /> 10;136 <br /> TRA14SOORTER RETAIN <br />