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Este l (' No. 9 5 f CJ <br /> F_RP.1S IPi.. <br /> IS� NON-HAZARDOUS SPECIAL v�JASTEEMA��IFEST <br /> USTFUS <br /> �::ia i� '..' ter,;!!,L., ` .... �• �a _-L� y t`i-. <br /> Generating LoCatioh — <br /> AderaSs T_ - pn��^ - ,� .F .Address A _ <br /> Piidne No, ! ! t�� T� �r—r�� !� 77_ t Phone <br /> rNo- <br /> Containers Type <br /> Description of Waste Ouantity Units No. T toe D-Drum <br /> C-Canon <br /> •JSTrv?'r DC••^"4 srJj�� cJ '� a O 8-gag <br /> T Truck,-, <br /> P.Poun(L• <br /> Y-Yards <br /> 01 0-Other <br /> I hereby certify that the above named material aces not contain free liquid as defined by 40 CFR Part 260.10 or any applicabte <br /> state law, is not a he?zrdous 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 /> � � � �R`• fir: -t <br /> c3,rsrattW MrttWa$U PeW Name _gya� 3ynswre a 0th . <br /> fU 1111,3111=0 <br /> FR i,--R 54910=90111 <br /> Truck No. i t1 — "' Phone No. <br /> Tra^spcRer Name �/; •/; '• ;; W i, ;:•" ,"� f ir.^.na r ✓r�.'rl. .�!�'a ^n.� . <br /> Driver Name(Print) <br /> Aderass r.r' - " ' r ' fi Vehicle License No.1state <br /> Vehicle Certification <br /> ! ^crevy cer:if`'thal :he =)ve named material was picked up I hereby certify that the above named material was delivered With- <br /> 1i4_1 ,acer::tor:site Estac auo,ve. out incident to the destination listed below. <br /> Z o I <br /> OP nr$rynntir6 .._._ Smpment Da!n lkner 8:5nrae dei:vey Oete <br /> r <br /> Phone No. <br /> . r1d•.rass <br /> I nereey certify that the aba'-a narned mt.tcriai haz been accepted and to the best of my knowledge the foregoing-is-true and accurate. <br /> ' P:.::re e'nv:-o•mcr:war _ _ _ . . �`_`Signac„re __ tieenu Oa» <br /> PASS OOD9 <br /> i . <br /> i <br />