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PFWasteERRIfNDUSTRIES No 1067847 <br /> Systems " NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> i - rnvr, rsr <br /> i(trator Name ` ,`..... -� Generating Location <br /> I -�_„, _ - <br /> r i <br /> ss ` "` �" Address <br /> Ile No t 11 Phone No <br /> F _ Containers Type <br /> I Waste Code <br /> Description of Waste QuantityUnits No T pE D - Crum <br /> ElB -Carton <br /> B - Bag <br /> T -Truck <br /> ❑' 1:1P - Pounds 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 /> lassified and packaged, and is in proper condition for transportation according to applicable regulations <br /> e or Authorized Agent!Name Signature Shipment Date <br /> TRANSPORTER <br /> r k <br /> No � Phone No <br /> transporter Name Driver Name (Print) <br /> fess - Vehicle License No/State <br /> i <br /> Vehicle Certification <br /> Jeby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> e generator site Igted_a�ove', out incident to the destination listed below <br /> r SI Shipment Date Driver Signature Delivery Date <br /> DESTINATION <br /> 41-. '1_ Phone No <br /> ate Name <br /> =—1 I -I - ij <br />'Jess <br /> by certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> o Authorized Agent SI nature Receipt Date <br /> PASS CODE <br /> ' BF1260 720 3M <br />