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OS SPACIAL AS7B BESTOS. MANIFESTI.NON HAZARD , <br /> It waste is asbestos waste, complete Sections i, II, ffi and No.Y ^ <br /> If waste is NOT asbestos waste, complete only Sections I, H and M. <br /> i. ..*. * NERATOR .. r . <br /> Pa <br /> Gendl`ator Name: lr 0 ` 1 "`" b. Generating Location- <br /> ' <br /> Address: <br /> 06 4 e W_tZ),1 doed. Address: T /7 PGC.)-t <br /> 6-t�Cly C U ice^, <br /> Phone No.: Z f. Phone No.: <br /> If owner of the generating facility differs from the generator, provide: <br /> Owner's Name: In. Owner's Phone No.: <br /> TYPE <br /> .�yy DM-METAL DRUM <br /> L BFI WASTE: CODE -7 4 Containers DP -PLASTIC DRUM 'S' <br /> B BAG <br /> /U,0111 �/t _?4goAlls cS49/L k. Quanti 1 f Unita No. TYPE BA -6 MIL. PWRAPC BAG <br /> 'Description of Waste: ; or <br /> T -TRUCK <br /> x 4 <br /> 0 - <br /> OTHER <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is ot a hazardous waste as tined by 40 CFR Part 261 UNITS <br /> n <br /> or 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 previously restricted hazardous waste subject to the Land Disposal Y -YARDS <br /> Restrictions,I certify and warrant that the waste has been tre i coordante 4 with the requirements of 40 CFR Part 268 and is no longer M3-CUBIC METERS <br /> a hazardous waste as defined by 40 CFR Part 261. Y3 -CUBIC YARDS <br /> O -OTHER <br /> Generator Authorized A ent Name Si re _ Shipment Date <br /> __. <br /> CLiDn II :TRANSPORT&{GeneratOr gomptete�s tl; ` " « "h. <br /> /7 ,TRANSPORTER I TRANSPORTER II <br /> 'blame: -,►�}*.c�✓ l�f / r �y h. Name: <br /> Name <br /> G� � 1 � � i. Address: r <br /> CA 4q51_32 <br /> ' Driver Name/Title: Lxo& Me)(1Q 7 j. Driver Name/ itle: <br /> /, RIN77TYPE <br /> V� ��77 PRIN7ITYPE P <br /> ad. Phone No.: C �ir /y©Z 7 Truck No.: k. Phone No.: I. Truck No.: <br /> 'Vehicle License No.IState: 3,�2 L m.Vehicle License No.IState: <br /> Acknowledgement of Receipt of Materials. Acknowledgement of Receipt of Materials. <br /> 61j�2 J/1 b n. <br /> rn+er Signature Shipment Date Driver Signature Shipment Date <br /> f3ctiOn III �_ _ ,. pEST1NATION (Generator DESTINATION mat e�:deattnatior►ate t eens a f.� <br /> Site Name: 0 �1f.lr J 1_47)7 /1 , Phone No.: <br /> .tea �o <br /> b. Physical Address: - d. Mailing Address: <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 /> 1 0 <br /> f Name of Authorized Agent S slurs Receipt Date <br /> tion IV ASBESTOS (Ge PH"841.g, for complete e.) <br /> perator's* Name: b. Operator's* Phone No.: <br /> Operator's* Address: <br /> d. Special Handling Instructions and additional information- <br /> F. <br /> nformation: <br /> FERATOR'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 /> ked, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and government regulations. <br /> '�nnrarn-'c* nlamr+ G' T.+lo <br />