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MWaste No 1067858 <br /> Systems TM 1NG-FERRIS INDUSTRIES NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> r y • � <br /> jerator Name y"`" Generating Location <br /> address Address <br /> F:E]' e No - - Phone No l___�� <br /> Containers Type <br /> 3F1 Waste Code m D- Drum <br /> Description of Waste Quantity Units No Typ <br /> lul G-Carton <br /> - B - Bag <br /> A T -Truck <br /> 1 ❑ W ElP - 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 /> generator Authonzed Agent Name Signature Shipment Date <br /> TRANSPORTER <br />'Isporter <br /> k No - Phone No <br /> Name Driver Name (Print) t - <br /> fess Vehicle License No/State f <br /> 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 /> tt a generator site listed above out incident to the destination listed below <br /> _-.�� <br />)FO Signature Shipment Date Driver Signature Delivery Date <br />;ite Name Phone No J <br /> N_ i V 1. i 4 .}.- ._ r tr .♦ , _ J. t <br /> Xfess M <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 /> �� <br /> is Authonzed A ent 5i nature Recei t Date <br /> PASS CODE <br /> ' SR260 720 3193 <br />