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.. No- 950774 <br /> 91SYstem INDUSTRIES <br /> t?IROW N1NNON-HAZARDOUS SPECIAL WASTE MANIFEST` <br /> G-FEf1R18 <br /> GENERAT <br /> O. <br /> Generator Name SA ••47-A t c 1,*'A Generating Location AL, )�4 <br /> Address 7 U E A ' r'Ar u t ,,F d Address {i QC TU•/ CA , <br /> riA: r J tw:'r1Riti,'� lA Z4oY <br /> Pione No. Phone No. <br /> 01 Waste Code ❑ ❑� ED Containers Type <br /> Description of Waste � Units No. T D• Drum <br /> L"I10 P] C-Carton <br /> Co�J 57kuL To-/ j>E^% o L, �^'4�JE% � B• Bag <br /> Lam❑ ❑ ❑ ❑ P Truck <br /> Y-Yards <br /> ] [:] M❑ ❑ F-10-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 /> classified and packaged, and is in proper condition for transportation according to applicable regulations. <br /> ,anatt„, S a <br /> TRANSPORTER <br /> Truck No. '` _ Sa rJ Phone No- '-) &gSo <br /> Transporter Name b,11A T'D-4CA .',rr Driver Name Print / <br /> Address 1T{;r 2 /Y ,4 Vehicle License NOJState ao'CO „r,� / <br /> Vehicle Certification <br /> I hereby certify that the above named material was picked 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 /> orashe Shonwd Dab D ro Signal ^ <br /> .- Delivery Date <br /> DESTINATION <br /> Site Name Phone No. —1 17-m <br /> _ 1 <br /> I hereby certify that the above named material has been accepted and to the best y k owled tae foregoing is true and accurate. <br /> Z <br /> Nano of AuthoredAQW4Si natnature <br /> Receipt Date <br /> t <br /> PASS CODE <br /> 10/!e BF1260-720 <br /> GENERATOR RETAIN <br />