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go <br /> Wast 1- 950773 <br /> A Systems ' HAZARDOUS SPEC► WASTE MANIFEST <br /> ItRONR1Y10 MIDUSTHIES <br /> GENERATOR <br /> Generator Name t)rvtri Fe. 1 K 1i LU/;`� f3eneratlng Location X41. Y <br /> Address l r/lr tL % Address <br /> Phone No. —� 1 - L 1 I —T-1 Phone No. <br /> BFI Waste;Code m ED I 1 1, 1 11 Containers Tyles <br /> D-Drum <br /> Description of Waste Quantic � C-Carton <br /> f kLl <br /> I El m El P-Truck Pounds <br /> Y-Yards <br /> I El m0 O-Other <br /> I hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260.10 or any applicable <br /> state law, is not a hazardous waste as defined by 40 CFR Part 261 or any applicable state law, has been properly described, <br /> classifiep and packaged, and is in proper condition for transportation according to applicable regulations. <br /> ++ l <br /> .. <br /> Shpvwd <br /> TRANSPORTER <br /> Truck No. _.. S �y - ���' t/�j o ^ <br /> Phone No. 0 <br /> Transporter Nam \ t <br /> Driver Name (Pn <br /> Address 6,) <br /> 1 Vehicle License NoJ8tate 7 1 <br /> yy/ VehicleCertificatkm 1 <br /> I hereby certify that the above named material"jCfti d up I hereby certify that the above named material was delivered with- <br /> at the generator site listed above. out incident to the destination listed below. <br /> t <br /> l 1.2 >' 1 <br /> Dover Signature Shipment Date diver SWahtre Delivery Data <br /> DESTINATION <br /> ( n <br /> Site Name Phone No. <br /> Address <br /> I hereby certify that the above named material has been accepted and to the best of m for ng is true and accurate. <br /> i <br /> Nome d Authmred enc Signature NeCeipl Date <br /> PASS CODE <br /> 10/88 SF1260-720 <br /> GENERATOR RETAIN <br />