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Waste No 1067856 <br /> Systems TM wNINr,FEARis INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> �.�-a. lei��:+ n1�.v ...rai iv_♦ 7 ��.7J <br /> lerator Name Generating Location <br /> ress i ` ' Address <br /> Ine <br /> No Phone No <br /> - <br />,FI Waste Code Containers Type <br /> � � � � 1 <br /> Description of Waste Duantity Units No Type D - Drum <br /> C - Carton <br /> F-1 11 <br /> J <br /> B - Bag <br /> T -Truck <br /> ❑ ❑ P - Pounds <br />' Y - Yards <br /> F1 <br /> Elm 1:11-1 O-Other I I F] <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 /> enerator Authorized Agent!Name Signature Shipment Date <br /> TRANSPORTER <br /> kNo r � `�� -- Phone No <br /> _ C_A�1_1 <br /> ransporter Name Driver Name (Print) <br /> ress Vehicle License No/State <br /> x Vehicle Certification - <br /> eby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> i e generator site listed above out incident to the destination listed below <br /> �t <br /> ' <br /> ,Cq y�y`t 0; f�; '.'V rr�J� <br /> Signaturb Shipment Date Driver Signature Delivery Date <br /> DESTINATION <br /> Arte Name Phone No <br /> less � l <br /> teby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> a Authorized A ent Si nature Receipt Date <br /> PASS CODE <br /> SF1260 720 3193 <br />