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Waste 8F'1 Acct _ Na- 10139042 No 906019 Systems TM WFERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFESTGENERATOR 1 �r V, ICJ Co I LWa= 1riy., s �i1 '-! rte. i�l5�i5r1c� i "fit Generator Name Generating Location — dress Address _ ,I ,r rMft C-9 95 205 JI tone Na Phone No L�-- __ m � `� rl � � Waste Code I � � U ' � 3 7 .. Containers Type Description of Waste Quantit Units No T pe D- Drum C - Carton s I `_,=i C t: t r i a t �C� a�, i t I F] �..� l 8 - Bag ❑ ❑ T -Truck P - Pounds Y - Yards ❑ El Other i i I hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260 10 or any applicable ' state law, is not a hazardous waste as defin@d by 40 CFR Part 261 or anapplicable state law, has been properly described, classified and packaged, and is in proper condition toirrsportatl actor Ing to applicable regulations t_ nerator Authorized Agent Name Signature Shcpment Date F–M&MIGIRM I ruck No ` �'��✓ �~ Phone No r I b b b 8 U 1 1 6 4 �rJ Transporter Name 1"t F tri, , r onn E4l Lo I Wit, f� p Driver Name (Print) ,� t1ii � iiztl �i a wit ddress Vehicle License No/State ts �# rr �t � � i i t " 1 �(jtr Vehicle Certification hereby certify that the above named material was picked up I hereby cgrtify that the above named material was delivered with- at the generator site list above ( out incige6t to the destin 'tion listed below f}nvar Scgnature Shipment Date (`- Drive�rSgnature Delivery pats E , DESTINATION )_A_4 U 1�"Clad cars I tol -y Lord ti I 1 rte Name Phone No 1L t3 t I vE r trc-,i c- , 1 .4 C:) I Iddress hereby certify that the above named material has been accepted and to the best of n)y,k'no'wledge the foregoing is true and accurate f Aulhonzed A ent Si nalur8 . �� 1 _ Receipt Date _ PASS CODE I DlSv BFI260 7?J UNLOADING AREA COPY