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• <br /> Waste No 1067848 <br /> S]/StTMtNG-t=>rRRIS INDUSTRIESSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> a a � <br /> n <br /> IratorNarne Generating Location <br /> ess ` Address <br /> i <br /> to No J Phone No <br /> - . _ - - Containers Type <br /> FI Waste Code <br /> Description of Waste Quanta Units No T pe D- Drum <br /> * ❑ M C - Carton <br /> FFF , I I B - Bag <br /> T -Truck <br /> Em ❑ P - Pounds <br /> ' 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 /> lasstffed and packaged, and is in proper condition for transportation according to applicable regulations <br /> I I <br /> e r Authonzed Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> r No IGD Phone No - <br /> ransporter Name - V- Driver Name (Print) <br /> less - � � � Vehicle License No/State <br /> r Vehicle Certification <br /> by certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> t �e generator site listed above out incident to the destination listed below <br /> slgrfaturShipment Date Driver Signature Delivery Date <br /> DESTINATION <br />.ite Name Phone No <br /> jess <br /> lh by certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> a of Authorized A ent SI nature Receipt Date <br /> PASS CODE <br /> SF1260 720 3193 <br />