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NON- (AZAR J5 "SPECIAL-WASTE & EESTOS. MANIFEST Ifwaste is asbestos waste, complete Sections I, II, ffi and IV. ': No. 606 2 If waste is NOT asbestos waste, complete only Sections I, fI and M. - tion ERATOR writ' �,t°1 b. Generating Location: Generator AName: ddress LjoEl{� e 'fDn d. Address: ♦J t V JCR APhone No.: Z� f. Phone No.: _ owner of the generating facility differs from the generator, provide: Owner's Name: h. Owner's Phone No.: (� TYPE t. BFI WASTE CODE rD ls� 'f �q 7 -7 qJ containers DM-METAL DRUM DP -PLASTIC DRUM B -BAG Description of Waste: ►Y �N H PJZA P-r�0� SO'L k. Quant' Units -No. TYPE BA -6 MIL. PLASTIC BAG or WRAP T -TRUCK O -OTHER GENERATOR'S CERTIFICATION: I hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Part 261 UNITS or any applicable state law,has been properly described,classified and packaged,and is in proper condition for transportation according to P -POUNDS applicable regulations;AND,If the waste is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Y -YARDS Restrictions,I certify and warrant that the waste has been treated in accordance with the requirements of 40 CFA Part 268 and is no longer M3-CUBIC METERS a hazardous waste as defimed,by 40yCFR`Part 26t. O _CUBIC YARDS Generator Authorized Agent Name ature Shipment Date h CtlOn II TRANSPQifi {Generator cornpfetti.$ ,Ir T pateae�h n I` Y TRANSPORTER ] ,� U TRANSPORTER II ame: �hh-»Q-� 1 )e rni -rra l— hh. Name: ddress: LS r e fZtad1. Address: n S©5e Si 2 Driver Name/Titl 9,42 J k I- Driver NamelTitie: . (�, PHINTlTYPE : PAINTlTYPE d. Phone No.: - V) _7174 � Z)yQ'Ge. Truck No.: k. Phone No.: _ I. Truck No.: Vehicle License No./State-� � mlVehi@e License-No.lState: Acknowledgement of Receipt of Materials. Acknowledgement of Receipt of Materials. n. - - nv ignature IT 47 Shipment Date Driver Signature Shipment Date action IIT ''DESTINATION ttaenerator aompkateg a f,'destf cart ail r eft .r ;.... Site Name: Va6 eD 649P I+r C. Phone No.: I L Physical Address: 00 d. Mailing Address: m Ori C.,t9 _T Discrepancy Indication Space: -- I hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate. 1 Name of Authored Agent Signature Receipt Date )Ctfon IV' ASBESTOS (Generator complete adrfrgaq> ator,wet mpl e� ` ". r ` perator's* Name: b. Operator's* Phone No.: Operator's' Address: U. Special Handling Instructions and additional information: tDERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, 'ked. marked, and iabeled.. and are in all respects in proper condition for transport by highway according to applicable international and government regutetions. Ofnprratnr'c' NVem- R, 70 - ---- --- - - -- -- —