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» 1 <br /> aste- <br /> -0 042 <br /> Systems TM <br /> "OWNING-FERRISINOUSTRIES .,NON-HAZARDOUS OUS SPECIAL WASTE MANIFEST <br /> 1 <br /> GENERATOR <br /> 3nerator Name Generating Location ` <br /> n��dress Box t 103 Address StGckt:on ca . <br /> One No —� f v� .Phone No <br /> 4 rl F 1G p -, � 4 Containers Type <br /> =1 Waste Code �7 - - , <br /> Description of Waste Quantit Units No T pe D- Drum <br /> ElC Carton <br /> 6 Bag <br /> E= T Truck <br /> F—] ❑ P Pounds <br /> Y Yards <br /> m� O Other <br /> 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 transportatiorv-according to applicable regulations <br /> �'ar:a is h P-ir)Griart <br /> er or Authorized Agent Name Signature Shipment Date r <br /> FAA 0. <br /> p <br /> lick No 14�P�1 i Phone No 6= ` <br />,nsporter Name r"t F -, i, _,r IT C- a�i,4 �e_ <br /> p Driver Name (Print)1911 I <br /> l <br /> ress Vehicle License No/State <br /> ? fl11 6 <br /> Vehicle Certification l L� -2_n <br /> ereby 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 /> L—L _L=l <br /> CL <br /> er Signature Shipment Date - Driver SFgnature Delivery Date <br /> DESTINATION <br /> ,1 <br /> Name _Masco Road Dani tare SLandfi 1 lr „ Phorie No � i —I 4 7 t7 a 3 <br /> dress � VcIB1-:1 r�_Vali Ll � =rrii� i,� h Ca 9,4750 <br /> reby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> of Authorized Agent Signature Receipt Date <br /> PASS CODE <br /> dH2o0 720 <br /> 5 ,1 <br /> GENERATOR. RET/kIi <br />