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Waste No 1067850 <br /> Systems ,11"I INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> INbUSTRIES <br /> r � • r <br /> ferator Name Generating Location <br /> kreSS F �4 . Address ••��.� ±.'n _ u��.... <br /> su •u ~ a � J.. ..Jv♦ i . <br /> Ine No "17-1Phone No <br /> Containers Type <br /> 3F1 Waste Code - D - Drum <br /> Description of Waste Uuantit Units No Type <br /> I(�Y�j C - Carton <br /> B - Bag <br /> - T - Truck <br /> I <br /> ❑ k ❑ P - Pounds <br /> Y - Yards <br /> ❑ ❑ 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 /> I I I 1= <br /> ie for Authorized Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> Tl�k No - - ry A Phone No <br /> Transporter Name J t Driver Name (Print) <br /> ress Vehicle License No/State <br /> s <br /> 4 Vehicle Certification <br /> l,reby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> it the generator site fi§tld abjeye out Incident to the destination listed below <br /> i <br />)r r Si Shipment Date Driver Signature Delivery Date <br /> L <br /> DESTINATION <br /> 31 t Name Phone No <br /> less <br /> eby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> f Authorized Agent Signature Recei 1 Date <br /> PASS CODE <br /> ' BF1260 720 3193 <br />