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PROWNINO-FERRIS <br /> Waste No900028 <br /> o r_ ISystems TMiJON-HAZARD INDUSTRIES OUS SPECIAL WASTE MANIFEST <br /> • <br /> Mid Cal LE - —nc IF'i^ n, — <br /> ienerator Name Generating Location <br /> P O <br /> Iddress 80- 5510? Address trSoct<tcn , Ga <br /> hone No Phone No <br /> LL-1 � }' 7 ' Containers Type <br /> 'FI Waste Code m' Description of `vVaste <br /> Quantity Units No Type D - Drum <br /> C - Carton <br /> B - Bag <br />' T Truck <br /> ❑ ❑ P Pounds <br /> Y Yards <br /> ❑ � ❑ O- Other <br /> 1 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 /> n rator Authorized Agent Name Signature i Shipment Date <br /> i <br /> luck No '- ' w 6 <br /> Phone No <br /> ansporter Name ` ' Driver Name (Pant) <br /> 2400 ?r_r' �r <br /> dress Vehicle License No/State "E } <br /> Baker-'flEld <br /> Vehicle Certification <br /> lereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> the generator site listed above out incident to the destination listed below <br /> rvNc, <br /> wer Signature Shipment Date Driver Signature Delivery Date <br /> II <br /> DESTINATION <br /> f <br /> 'v'ascO ROal Sanitary t_ar> dfi71 <br /> Ie Name Phone No ! 0 <br /> ddres$ ` i Ec7�t h�a l �� =r ri )re , Ca - 91550 ! <br /> 1 <br /> I <br /> Ireby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> e <br /> of Authorized A ent Si nature ReceiAt Date <br /> 8o PASS CODE <br /> Bnizsc azo <br /> GENERATT1p DUTA1Iy <br />