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Waste No 1067843 <br /> Systems TM PWN1N0.F!ERRlS NON-HAZARDOUS SPECIAL WASTE MANIFEST <br /> MININDUSTRIES <br /> lerator Name Generating Location __7-1 <br />�ress `y R Address <br /> Ine No y Phone No <br /> 3FI Waste Code r U J J L Containers Type <br /> Description of Waste Quantic units No T pe7TT 11 1 D Drum <br /> a C -Carton <br /> ter _ B - <br /> Bag <br /> T - Truck <br /> ' ❑ m ❑ P - Pounds <br /> Y -Yards <br /> ❑ m ❑ 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 /> s for Authorized Agent Name Signature Shipment Date <br /> TRANSPORTER <br /> k Noa Phone No <br /> Transporter Name Driver Name (Print) L�� <br /> Allress Vehicle License No/State <br /> Vehicle Certification <br /> I Ireby certify that the above named material was picked up I hereby certify that the above named material was delivered with- <br /> at th generator site listed above out incident to the destination listed below <br /> Driver S+gnaturb Shipment Date Driver Signature Delivery Date <br /> DESTINATION <br /> SName Phone No <br /> A cess <br /> I reby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> f <br /> Ngr of Authorized Agent Signature -Receipt Date <br /> PASS CODE <br /> SF1260 720 3/93 <br />