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�1 <br /> +� <br /> °�^$al <br /> te' No. 951503 <br /> stems TO NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> �'OWr/1Mfl-PL`RRt9 lur$tJSTgIL3 <br /> nerator Name Generating Locationl <br /> dress 1L•77K AddreSS <br /> one <br /> eNo. <br /> " G( l c) Phone N0. <br /> r�Vaste Code Q13 {...I L/ 17 V O Containers TYPO <br /> Description of waste Quantity Unit* No. T . <br /> 0-Drum <br /> �twil <br /> 1 4 O Li ® aSa <br /> SS o <br /> f��'Yf r s. i r h•• g aQ <br /> 7 F m ❑ P-t�.�.,� <br /> -Verds <br /> .`.... __ ❑ m ❑ O.Outer <br /> I heroby certify that the above named material does not contain free liquid as definwd by 40 CFR Parr 2A0.40 or Any applicable <br /> *lata 10r., ie h0l. a hazarduuz w=tc ny defined by 40 CPR Part 261 or any applicable state law, has been properly oescrlbeo, <br /> classified and packaged, and is in proper condltlon tot transpo �hon according to applicable rogulatione. <br /> •.Plw Awthw+rW Ay.nt Nume Snipment mime <br /> TRANSPORTLR <br /> Ick No. Phone No.. 7/c-"` <br /> In2portar Noma ! Driver Name(print) <br /> dretsa �'~ �^�' ' / •T '� Vehicle Ucenae No./$tato <br /> "� • Y24 Venicle Certiflcatlun <br /> erebr cenity that the &bore named material woo piokod up I hereby certify that the above named material was delivered with. <br /> the generator site Ilstetf ShOVA. out incident to the destination listed below. <br /> ✓ r 1 • <br /> ssivne r nam 5;var SlOnsnrs owlinary Date <br /> DESTINATION <br /> e Name__ EPIonaNa. . <br /> Idres�e . _ _ � , <br /> ereby coriity that the above named mater;al has been accepted andmy ledgethe foregoing Is true and aCCurIIte. <br /> R Dib <br /> Rte et AutMx:zoo r ant <br /> PASS COM <br /> eFlxoo-7xo <br /> MANsronTEn nETAIN <br /> a� •err �rloHd waz1� <br />