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PING-F <br /> •ERRIS INDUSTRIESES Waste No 1067854 <br /> Systems NONHAZARDOUS SPECIAL WASTE MANIFEST <br /> mum <br /> Ilerator Name " " `g3_ Generating Location <br /> ress c- Address �_ L <br /> line No Phone No <br /> Containers Type <br /> 6FI Waste Code m - - <br /> Description of Waste Quantity Units No T pe D - Drum <br /> ElC - Carton <br /> B - Bag <br /> T -Truck <br /> ' ❑ m ❑ <br /> P - Pounds <br /> Y - Yards <br /> El 1:1O- 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 /> ie tot Authonzed Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> T k No Phone No <br /> transporter Name Driver Name (Print) <br /> Iress Vehicle License No/State <br /> Vehicle Certification , " r ' T .� <br /> eby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> 3t t e generator site listed above out incident to the destination listed below <br /> r Signature Shipment Date Driver Signature Delivery Date <br /> DESTINATION <br /> Me Name Phone No �— - <br /> Nlress <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 /> J of Authorized Agent Signature Receipt Date <br /> PASS CODE <br /> ' BF1260 720 3j93 <br />