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No <br /> 0-3-2---- <br /> — <br /> Systems TM <br /> P40WNING�FERRIS <br /> ' <br /> INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> r <br /> s_e -i 154 ? F Chn1 <br /> enerator Name _ Generating Location <br />' <br /> ddre5s <br /> P 0 80Address <br /> - 55103 Stocktc)n , La <br /> - �1ir �I�{ _ --TIIII �JIII <br /> hone No Phone No <br /> FI Waste Code ❑❑ ❑❑� , Q 1 3 ! 3 ' 1 51 1 Containers y Type. <br /> Description of Waste Quantit Units No nB <br /> D - Drum <br /> ElmC - Carlon <br /> - 6ag <br />' T Truck <br /> - ❑ � ❑ P - Pounds <br /> Y Yards <br /> 1 h <br /> j��� o'atner '- <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 /> \ t <br /> d K Ri neha, t <br /> nerator Author zed Agent Name Signature Shipment Date <br />�uck No clr_ 0CJ'CZ Phone No - - <br /> ansporter Name - Driver Name (Print"::_1A•� k o <br /> dress' _ Y Vehicle License No/State <br /> D u kc-t,s f� e ; C a S 3 0 Vehicle Certification <br /> ereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> t the generator site listed shove out Incident to the destination listed below <br /> I; J <br /> Z54— <br /> __ LTi _ s �' /I ' ! <br /> _❑ '3—� c i <br /> rver grl�iWre hipmen Date' c5� er Ssgnaiure Delivery Date r <br /> DESTINATION <br /> e NametJ`�sco P.oad ^ i try !:;,d 4 d 7 <br /> y Phone No f <br /> ddres5 IOU ! 1 �Gv r CcG r �,c +I^�,"'� , Ca . _.550 <br /> ereby certify that the above'named material has,been accepted and to the best of my knowledge the foregoing is true and accurate <br /> e Authonzed A enl Si nature �Recespt Daiet]aie i <br /> r ' <br /> , f <br /> a PASS CODE <br />�6 6F1280 720 <br /> r <br /> vE NERATOR RE=TAIN <br />