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wtr�ete. R M <br /> 4 ¢J ii waettls NOT asbestos wttiti, Omptete artly Sectkxts 1,'U and Al 3x " <br /> g <br /> It. for Name b Generating Location <br /> D. Address a �" d Address <br /> e Pfwne No Q " . f. Phone No <br /> It owner of the generati facility diffem from rator, e - - - - <br /> g Owner's Name h. Owner's Phone No � f�d <br /> TYPE <br /> I OF[WASTE CODE ® Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> LA <br /> B SAG <br /> I Description of Waste _.. � ��! 1- Ouand tk& NO TYPE BA - <br /> sc6 MIL PLASTIC SAG <br /> or WRAP <br /> T -TRUCK -'-1 <br /> O -OTHER <br /> GENERATOR-9 CERTIFICATION I hereby certify tttd the above*tamed materia!Is ira-te as defined by 40 t*R Part 201 ,`_ UNITS <br /> er,any aWl able state taw,has been properly described,classified and packapad,and Is in proper condition for tranaponadon according to LM3-CUSIC <br /> S <br /> appttcabte regulations.AND,if the wast!N a treatment realdae of a prsvkm*restricted hazardous waste subject to the Land Dispoeal ry <br /> Restrksions,t certify and warrant that the waste has been treated In accordance with taw requirements of 40 CFR Part 288 and is no longer Ma hazardous waste as defined by 40 CFR Part 281 = YARDS <br /> r is <br /> A&CE S Toa t*& <br /> Ganeraim Authorized Agent Name Sigrw Shipment Date <br /> TRANSPORTER I ^c '` TRANSPORTER R <br /> h Name <br /> Mwess —2 r J S— i Address <br /> s <br /> pnDriver Name/Till. ; t Driver flame/Title TYPE 1 <br /> TYPE <br /> d;Phone No ' • Tnwk No I It Phone No 1 Truck No <br /> f Vehicle License No /State 2-20:1202 - C-a A m Vehicle License No /State <br /> Acknowledgement of Receipt of Materials Acknowledgement of Receipt of Materials <br /> 0- _ -� .c► l n <br /> WNW sp iewn sou t]we t7~sipnrure ttthiprnwr Dere <br /> N <br /> a Site Name c Phone No 4�W !S442 <br /> b Physical Address AV,1, d Mailing Address <br /> is Discrepancy Indication Space <br /> I hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> f K 1114 ( 11 <br /> wNns of Authwtzed Agent 14eosipt CWW <br /> OAK M Iv x ��n ASBESTOS (Genermor osnipiste "eflnrllteiea+f ` ,- <br /> Wrator's* Name Operator's* Phone No <br /> c Operator's' Address <br /> d Special Handling Instructions and additional intormatron <br /> OPERATOR S CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described agave by proper shipping name and are classified <br /> packed marked and labeled and are in all respects in proper condition for transport by highway according to applicable international and government regulations <br /> e Operator's" Name & Title <br /> P rt,T,pe noerator," c c—urr late <br />