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PFERRIS INDUSTRIES Waste No 1067841 -- <br /> Systems TM NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> Inerator Name =` `F Generating Location <br /> dress G Address <br /> one No I - Phone No <br /> BFI Waste Code m - - Containers Type <br /> Description of Waste Quantit Units No T pe D - Drum <br /> F-1 II C -Catton <br /> ., B - bag <br /> T -Truck <br /> ❑ m ❑ P - Pounds <br /> Y -Yards <br /> O-Other <br /> E El _ . <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 /> !or Authorized Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> ck No Phone No <br /> Transporter Name ` Driver Name (Print) l <br /> i -dress Vehicle License No/State <br /> Vehicle Certification Nf <br /> ereby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> a the generator site listed above out incident to the destination listed below <br /> .° <br /> Mer Signatu a Shipment Date Driver Signature Delivery Date <br /> DESTINATION <br /> Site Name Phone No <br /> dress s <br /> I by certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> Wine of Authorized Agent Ss nature iiecei t Date <br /> PASS CODE <br /> ' 1 Br1260 720 3193 <br /> r' •r T tet; tam�r.�i�i <br />