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��o�-�0 3 <br /> • SUPERIOR NON-HAZARDOUS <br /> uper�o� WASTE MANIFEST <br /> c�st. #: s�te: <br /> - . � . <br /> Name �.� .... �� � � n-�.^ Generating Location�,rc��.�r- a��S z� <br /> �dress?S�� �����:...� �r-, i t Z.y 5�r-_�� I,.:i� ,�a , <br /> �,,,,,e � }�1�� - S-<_3 .:i o t. L. <br /> one No.M14� � ^ 'tl �l � ._ ZCp �' 3 P�of;�e No. o -o - a a o a - o • �� <br /> DE : yyASTE CODE WASTE DESCRIPTION GIUANTITY UNITS <br /> �DRUM <br /> BAG -�"' -, �, <br /> CARTON �`g�- � � ��� �-��c�."S,�r�3 t_.�ci� �� � <br /> P-POUNDS t1 <br /> �-YARDS : ' �r-..,,� F-1 51�'��f-a�, _�J e�r�,- ".�. � � 5 �� <br /> TONS '� � ---' �_, C� <br /> OTHER -i�-�-i...-�� 1 '�-,1.. A c tx���. �.1�z� � �� , <br /> I hereby certify that the above tisted material(s), is(are) not a hazardous waste as defined by 40 CFR Part 261 or any appiicable state law.That <br /> �ch waste has been properly described, classified and packaged, and is in proper condition for transportation according to applicable regula- <br /> ns. <br /> - Zv -t� ,� :Z1� <br /> -� , <br /> THORI ED AGENT'S NAME (PRINT) DATE GNATU E <br /> � � � � � � � . <br /> me �t� i� �r. �. �v�r . Phone No. �� 3 � �f 2-� Z'�1�f <br /> dress?��:=i �y.�►:,�,� �r � �! �,�d.�' Y`�r,�r�-, :,... tv . �; ��'�y <br /> - . • � - . <br /> � 2�..— , <br /> �me �l � '� C�� Phone No. ��t--'`� <br /> �^ • ,� A .. <br /> Address / ��� � � Driver's Name - '/ ���°�r� -� <br /> "�,--� �3"� ' vehicle's No. /� 3 <br /> ereby certify that the above named material was picked up at the Generator site listed above and delivered without incident to the disposal <br /> facility listed below. <br /> ' � , _ <br /> �,,3�G`L c. � ,� ���..�'z:'Z <br /> SHIPMENT DATE DRIVER'S SIGNATU DELIVERY DATE IVER S SIGNAT <br /> � � � � � <br /> �ite Name Superior FCR Landfill, Inc. Phone No. 800-963-3158 <br /> ddress 175 Co. Rd. 37 N.E., Buffalo, MN 55313 <br /> �ermit No. SW60 <br /> h►ereby certify that the above material has been accepted and that information presented on this document are true and accurate. <br /> AME DATE SIGNATURE <br /> White Copy-Generator retains at time of loading Ticket No. Tons <br /> ellow Copy-Hauler retains after delivery to landfill <br /> ink Copy-Landfill retains Yards <br /> Gold Copy- Facility mails to customer <br />