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:+.: ,.. a -v:r`w ''}' '�"r•f s,.. �r �,�„ _ •6+]t, - ..r•�. �r..-.r s. <br /> HAZAROWS ,SPECIAL WASTE &ftBESTOS MANIFEST.608 <br /> " . . <br /> 16 1 <br /> If waste is asbestos waste, complete Sectlons L IlL, M and IV.w NO. <br /> If waste is NOT asbestos waste, complete only Sections I, II and III. <br /> ERATOR (teener <br /> Gerator Name: Qb. Generating Location: �LI C•f—C <br /> y� r�ergftvl <br /> Address: <br /> ©0 d. Address., <br /> thone No.: C f. Phone No.: <br /> if owner of the generating facility differs from the generator, provide: <br /> lOwnor's Name: h. Owner's Phone No.: <br /> � / IYPE <br /> � 7 G Containers DM-METAL DRUM <br /> I. BFI WASTE CODE V D 1 9 7 7 DP -PLASTIC DRUM <br /> B -BAG <br /> jibescrption of Waste: <br /> / BA _g MIL. PLASTIC BAG <br /> IV 061 L(S . DI Ouanti ,°G l nits No. TYPE <br /> or WRAP <br /> T TRUCK <br /> 0 OTHER <br /> tENERATOR'S CERTIFICATION: I hereby certify that the above named material is not a hazardous waste as defined by�CF11,3art 28l UNITS <br /> r any applicable state law,has been properly described,classified and packaged,and is in proper condition for transportati8n according to P -POUNDS <br /> r <br /> applicable regulations;AND,If the waste Is a tr+pptmerit 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 Ire actor ante with the requirements of 40 CFR Part 288 and is no longer Ms CUBIC METERS p <br /> a hazardous waste as defined by 40 CFR Part 281. Y3 CUBIC YARDS #� <br /> 0 -OTHER <br /> Generator Authorized Agent Name slurs Shipment Date <br /> t.Complete e'9 , rr <br /> J,c_tion II TRAN3P©RTER(Generator compute a d; Uromptere I,ri l „r <br /> TRA1 `NSPORTER I ,.,'iRANSPORTER II f <br /> ams: t I -Tru cAJ h. Name: - <br /> 0- Address: <br /> _ 6err �. I. Address: <br /> Sa_ ri .dose g��i3� <br /> Driver Name/Title: M J._Driver NamelTitle: PRINTITVPE - <br /> /�1n PRINTIT�rPE '-' <br /> d. Phone No.:(LtOB� ��`, e. Truck No.: k. Phone No.: I. Truck No.: <br /> Vehicle License No./State: m.Vehicle License No./Slate: <br /> Acknowledgement of ipt of Mat 'als. Acknowledgement of Receipt of Materials. <br /> n <br /> D er atUrs Shipment Date Driver Signature Shipment Date <br /> r' DE5T1NATfON (�iBrlerator colrlptt#+3s it d, plates a }" "` ��� x a <br /> Section" G0"' rr <br /> Site Name: OL _. n i i r tA Ln 6dAAC. Phone No.: 51 Q_ 4(47-0Q 6? ' <br /> �. I r� <br /> b. Physical Address; (400 1 t v �O�"' d. Mailing Address: <br /> 11umorC.� - <br /> 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 /> �7 E Ftt <br /> f Name of Autnanzad Agent Signature Receipt Dale <br /> action I _ ' ASBESTUS (Qerlerattor oprtiplele ate,t,g, • compfetes'0.) <br /> perator's' Name: b. Operator's` Phone No.: <br /> Operator's" Address: <br /> d. Special Handling Instructions and additional information: <br /> ERATOR'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 /> eked, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and government regulations. <br /> Nam- R, Till — <br />