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Waste No 1067844 <br /> Systems TM <br /> NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> PVMING-FERRIS INDUSTRIES <br /> erator Name CiRCC `_=""` Generating Location <br /> ress - "3• ' Address <br /> ).� i4a .. • r� -... - <br /> \ w r <br /> Ine No � - - { - Phone No <br /> 3F1 Waste Code - I - - - - Containers Type <br /> Description of Waste Quandt Units No T pe D - Drum <br /> m ] - Carton <br /> B <br /> _ u 8 - Bag <br /> T -Truck <br /> ' ❑ m ❑ P - Pounds <br /> Y- Yards <br /> m F-10-Other <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 /> 3e for Authorized Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> Tjk No '. _I` A ry Phone No <br /> Transporter Name Driver Name (Print) <br /> ress 1. A Vehicle License No/State <br /> Vehicle Certification <br /> eby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> re generator site listed above out incident to the destination listed below <br /> - > - <br /> r Signature Shipment Date Driver Signature Delivery Date <br /> DESTINATION <br /> Ura . n. `-�-� i\4• �.Yi i ul_a A a . .- a �" , � i <br /> Site Name Phone No <br /> jress <br /> reby certify that the above named matenal has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> 4 at Authorized Agent Signature Fiecel t Date <br /> PASS CODE <br /> ' SF1260 720 3193 <br />