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PWaste No 1067849 <br /> Systems T" NON--HAZARDOUS SPECIAL WASTE MANIFEST <br /> WNIMO-F!ERRIS INDUSTRIES <br /> aerator Name "` y" '�" - Generating Location '�= 'S"'T1�_; ` <br /> ress <br /> _ _ Address <br /> Ine No Phone No <br /> 317I Waste Code m - r - - - Containers Type <br /> Description of Waste Quandty Units No T pe D - Drum <br /> J ❑ r`�I u -Carton <br /> B - Bag <br /> _ T - Truck <br /> ' ❑ W ❑ P - Pounds <br /> Y -Yards <br /> T-7 ❑ 1:1 O-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 /> ae for Authorized Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> l k No'-- ' Phone No <br /> transporter Name Driver Name (Print) <br /> Vehicle License No/State <br /> Iress � � <br /> Vehicle Certification <br /> aIeby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> fe generator site listed above out incident to the destination listed below <br /> r Signature` Shipment Date Driver Signature Delivery Date <br /> DESTINATION <br /> Site Name Phone No <br /> A ress <br /> reby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> V of Authorized Agent SI nature Receipt Date <br /> PASS CODE <br /> ' 6F1260 720 3193 <br />