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956002 <br /> este No <br /> ystems <br /> � . <br />!ROWNING-VERFOS iti&)STRIES w _f _ NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> pnerator Name a uC"�S Generating Location -_�6� TM-I 6,,j- * 21 .50 <br /> address 4 �0 � !go _12 11 <br /> Address 7()0/b KI , eL WKjQ j gj-� <br /> C Ig 9 4 Ll U—2�—_ S-�oC KTP G R <br /> Prone No �— <br /> d ! C) -210 Containers Type <br /> t tion of Waste Quantity Units No T' e D-Drum <br /> �W O uS Sol L d O ( © ® c-Carton <br /> S -Bag <br /> 4 T -Truck <br /> El:= El P-Pounds <br /> Y-Yards <br /> ❑ ElO-Other <br /> ere y cer`ti hat the a oes not contain tree liquid as defined by 40 CFR Part 260.10 or any applicable <br /> statel,Iaw, 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 /> 1>112w Kms'k2py— — <br /> Agent Name _ _ Signature Shipment Date <br /> a 7 <br /> s' w Phone No. o b <br /> .t <br /> Driver Name{Print) <br /> 3 - h <br /> Vehicle License t4oJState z lrl> <br /> * - Vehicle Certification <br /> Medal was picked up I-hereby certify that the above named material was delivered with- <br /> out Irde t destination tested below - - - <br /> Shipment Date Driver Signature Delarery Date <br /> Phone No � -- � 1414 1 <br /> U ve7zVh o e- GFx, 014 515 o _ <br /> ial has been accepted and to the best of my�vi Nge the foregoing Is true and accurate <br /> Si nature <br /> C ecelp at <br />� C <br /> 7 y PASS CODE <br /> s "4 OF1260-72o <br /> �, , TER RETAIN <br />