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Waste No 1067852 <br /> Systems TM PWNINO.F"ERRIS NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> INDUSTRIES <br /> Iterator Name ` Generating Location y` <br /> ress Address <br /> FT_= <br /> ne No - I� Phone No I� <br /> BFI Waste Code L—L - 14 - 1 - H - - Containers Type <br /> QuantityUnits No T pe D - Drum <br /> Description of Waste7T, IL ❑ C -Carton <br /> B - Bag <br /> T -Truck <br /> El== ❑ I ❑ P - Pounds <br /> _ Y -Yards <br /> F-1 ]� 1:1O-Other <br /> I hereby certify that the above named material does not contain free liquid as defined by 40 CFR Part 260 10orany 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 /> G for Authorized Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> f _ <br /> T k No � V M~ `+ Phone No <br /> Transporter Name Driver Name (Print) <br /> Alress Vehicle License No/State �r J <br /> Vehicle Certification L <br /> I Ireby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> at the generator site listed above out incident to the destination listed below <br />[)Mbr Signature Shipment Date Driver Signature Dehvery Date <br /> DESTINATION <br /> Site Name Phone No <br /> � r <br /> ress <br /> I reby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> N e of Authorized Agent Si nature Receipt Date <br /> PASS CODE <br /> ' - BF1260 720 3193 <br />