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.�. ` <br /> r , h�. 950777 <br /> l.'' ::r <br /> i`--.!-'HAZARDOUS SPECIAL V'JiaSTE MANIFEST <br /> --__-- ---- -.- --- .aeneraling LocationZrass — -- <br /> ---- T. ._. Address <br /> Phone No. FT <br /> ��__�____��--_ <br /> .—L—L_1�L_ <br /> Containers Type <br /> or' Of Was"a J Quanti C / Unit's N No i r pe C- <br /> , C•Canon <br /> B-Ba <br /> t + i 11-pounds <br /> rr y-yards <br /> TT-71 ❑ W 0- <br /> Otho <br /> -,eir95y c-x;Jy 'a-.L: Lr,a -.'e nanle0 Ilia-=r;a! 0025 nor contain 1r?'e quid as defined by 40 CFR Part 260.10 or any applicable - <br /> :ate fav;, is not a Yiaza!__u5 4t.:s'.2 as deiirte:, by 40 CFR Pa^. 2S _r a.ny applicable state law, has Ceen properly descrnbed, <br /> r.1a..lfled :_^r a-a G! t!anS OC< <� a+ -,:Dt n <br /> p d° g to applicable regulations. <br /> .,,t n 00 !C iu3ti 4L S.'nS:7rn ShIpI/1eGi Date <br /> , <br /> Tr6ck 'No. _ Phone No. .� ?'! '•'`'' -- 1 <br /> r . ,• , _. . ..ra --- - —' _ ._. — Driver Name (Print) f"I <br /> Vehicle license NoJState / t <br /> Vehicle Certification <br /> _`y•:. ," <� ;; _ _ n :cr ai :vas picked up i hereby certify that the above named material vYas delivered udh- <br /> {; out incident to the destination iistad belov. <br /> - a _ :k'RI At[We <br /> '�.^�rDt"tt'Signwu'e Drd;ry /Date`',.• 7�} <br /> _-. _ .,._ f + �.lnt-•S�'le s�+r..( ! 'Y"''" �t. .r +. �^4ac"74 . 4Ar_L• ;1� <br /> .. ._... ------- — — -- -- Phone No. <br /> it <br /> twe.isi ha oeer accepted and to the bes.*4f.my,knowledge'the foregoing is true and accurate. <br /> p�� <br /> rwy Pt Dat& <br /> ' PASS COOS <br /> eF�.�730 <br />