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OJACER,TRAC ,,OR SERVICE _ <br /> NON-HAZARDOUS MANIFEST - <br /> GENERATOR NAME l g c k4 L M ..GENERATING LOCATION <br /> ADDRESS 1112-go <br /> c• , <br /> CIIY,,STATE & ZIP �/ S PHONE # <br /> CONTAINERS: NO. VOLUME WEIGHT <br /> TYPE: TANK TRUCK I DUMP TRUCK DRUMS. OTHER <br /> �. WASTE DESCRIPTION: _ GENERATING PROCESS <br /> o. DESCRIPTION OF WASTE :., QUANTITY. y TYPE ' <br /> w 2• <br /> PROPERTIES: PH SOLID IQUID SLUDGE SLURRY ,OTHER i <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 APPLICABLERFqUL <br /> TIONS. <br /> F Typed or Printed Full N e and.Signa ure n Date ` <br /> NAME /l�li',� y*.arfiF n �P✓L�j J -{, TRUCK # Z 1 _' f <br /> ADDRESS 1��1 � � / 7a DRIVER NAME <br /> :R CITY, STATE & ZIP, . �r7Mi f � 'S�Sb SERVICE ORD R# <br /> . <br /> PHONE �'� <br /> yped or Priv ed Full Name and jgne y . - Date <br /> f DISPOSAL FACILITY PHONE'# <br /> i ADDRESS DISPOSAL METI iOD ,.. <br /> CITY. STATE & ZIP, LANDFILL -OTHER.... <br /> q • - Typed or Printed Full Name and-Signature. _~ n Date- , <br /> DISCREPANCY: <br />