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aWaste No 1067857 <br /> SystemsTm <br />! NING-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> jeratorName Generating Location ^� ±"��•' s <br /> address ''�' "" ' ` Address <br /> 1ne No Phone No <br /> - Containers Type <br /> R Waste Code m I- - - <br /> Description of Waste v Quante# Units No T pe C - Drum <br /> - FFF 1 , L 1 � Ll C - Bag <br /> T -Truck <br /> ❑ m � P - Pounds <br /> ' Y - Yards <br /> ❑ L__.� J ❑ O - Other <br /> 1 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 I I-T-171_ <br />,enerator Authonzed Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> ispork No _jjl Phone No <br /> ter <br /> Name V Driver Name (Print) - -- <br /> _ - T <br />'t1ress Vehicle License No/State <br /> Vehicle Certification ` <br /> eby certify that the above named material was picked up I hereby certify that the above named material was delivered wlth- <br /> t e generator site listed above out incident to the destination listed below <br /> nIff Signature Shipment Date Driver Signature Delivery Date <br /> DESTINATION <br /> W 1 r <br /> site Name 1 � J - , �i i �� � y� J Phone No <br />,#esr> <br /> e certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> I I I 1= <br /> a Authorized Agent Signature Receipt Date <br /> PASS CODE <br /> ' 13F1260 720 3193 <br />