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' NON-HAZARDOUS SPECIAL WASTE & ASBESTOS MANIFEST <br /> r <br /> ,r.-- <br /> If waste is asbestos waste, complete Sections Ir n, III and 1V NO 606110 <br /> If waste is NOT asbestos waste, complete only Sections 1, 1'I and IIl <br /> lol: -�� _ GENERATOR powwow at �� Y <br /> ��// PLC-1 <br /> r �/ K <br /> Gen/drator Name C/� b Generabrig Location a 0- <br /> Cress <br /> �Ad{iress 7rfl 4eq - 7>/PGT rf <br /> S d Address - <br /> C <br /> 7 <br /> Phone No CD8 b 00/a f Phone No <br /> If owner of the generating facility differs from the generator, provide <br /> ner's Name <br /> h Owner's Phone No <br /> I BFI WASTE CODE f('_IlQ I (� TYPE <br /> ,t�� Ho ,-�IqT,01j] Contamers DM-METAL DRUM <br /> f ascription of Waste AY Q /f/3ZJ9�C BP -BAGSTIC DRUM <br /> d �-k Quanii Unis No TYPE BA -6 MEL PLASTIC BAG <br /> ETm R WRAP <br /> -TRUCK <br /> O -OTHER <br /> ENERATOR S CERTIFICATION i hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Part 261 UNITS <br /> r any applicable state law has been properly described classified and packaged and is In proper condition for transportation according to P -POUNDS <br /> applicable regulations AND,if the waste is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Y -YARDS <br /> Restrictions I certify and warrant that the waste has been treated in accordance with the requirements of 40 CFR Pan 268 and is no longer Ms-CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261 <br /> y Y3 -CUBIC YARDS <br /> O OTHER <br /> Generator Authanzed AgET-= <br /> ent Name Slgnat <br /> Shipment Date <br /> flan iI TRANSPORTER{Generator complete a-d, rt <br /> -7 <br /> TRANSPORTER I0 TRANSPORTER II <br /> ____7 <br /> me <br /> ' r1 h Name <br /> (dress �S30 i�7er/1 S4{, Q&I,q( I Address <br /> river Name/ritle l��i✓ G Ci 1 driver NamelTitle - <br /> INT TYPE PRINTYPE <br /> 77 <br /> Phone No a Truck No k Phone No I Truck No <br /> liehicle License No Islets �Q m Vehicle License No IS to <br /> cknowlidg?pent of Recetatenals ,r Acknowledgerrten of Receipt of Materials <br /> I <br /> In <br /> aver Sgnamre Shipment Date Drlvw Signature Shipment Date <br />)ectlon.III DESTINATIONN�MmISrator compistes`aI dsWnatlorl tfte 0 04) <br /> lite Name `� f? /�/•."}� h� / <br /> c Phone No `15-101 <br /> Physical Address �QU /V C� .st O /eOC1d d Mailing Address <br /> z1wr d.-(f, e4 <br /> liscrepancy Indication Space <br /> hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing Is true and accurate <br /> l� <br /> Name of Authorized Agent Signature ReceiP't Data <br /> 1ion N ASBESTOS (Gerierator complete&A f,g,apsrow-a xnpllasr e) <br /> erator s` Name b Operator's' Phone No <br /> perator's* Address <br /> Special Handling Instructions and additional Information <br /> ATOR S CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified <br /> tl marked and labeled and are in all respects in proper condition for transport by highway according to applicable international and government regulations <br />