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PIAACER TRACTOR SERVICE <br /> NON-HAZARDOUS MANIFEST <br /> GENERATOR NAME <br /> L af V r .-t GENERATING LOCATION <br /> ADDRESS" n <br /> CITY, STATE &ZIP 9SPHONE # <br /> CONTAINERS: NO. VOLUME <br /> WEIGHT ' <br /> -TYPE: TANK TRUCK UMP TRUCK DRUMS OTHER <br /> WASTE DESCRIPTION: GENERATING PROCESS <br /> pp� DESCRIPTION OF WASTE QU "iY' TYPE' , <br /> w 2. <br /> :x <br /> t7 - <br /> PROPERTIES: PH SOLID IQUID - SLUDGE SLURRY OTHER '. . <br /> HANDLING INSTRUCTIONS: <br /> THE GENERATOR CERTIFIES THAT THE WASTE'AS DESCRIBED IS 100%NON-HAZARDOUS AS <br /> DEFINED BY 40 CFR PART 261 OR ANY APPLICABLE STATE LAW, AND HAS BEEN PROPERLY <br /> _"DESCRIBED, CLASSIFIED AND PACKAGED AND IS IN PROPER CONDITION FOR TRANSPORTA- <br /> TION <br /> RANSPORTATION ACCORDING TO APPLICABLE REGULATIONS. <br /> Typed or Printed Full Na*and Signature Date <br /> NAME ' C�' K c)�!__gr 1 C[ 'TRUCK # h <br /> tx . <br /> ADDRESS1 2 'DRNER NAME 1 <br /> N Crit, STATE & ZIP� C2�J/•C �h� ��,�Sd SERVICE ORDER # <br /> PHONE <br /> e or Printed Full Name and SfgnaXfe . Date <br /> DISPOSAL FACILITY � f1 STY ki "PHONE <br /> Z ADDRESS „ "7 , ) C: DISPOSAL METHOD <br /> -0 . .- <br /> CITY, STATE & ZIP� 8 1--;1 rs/a� DFILL - `" " " OTHER <br /> 2 <br /> A Typed or Printed Full Name and Signature. Date <br /> DISCREPANCY: <br />