Laserfiche WebLink
+4. .:..®. _ - , ids V • .-. i <br /> fso <br /> S SPECIAL WASTE ABESTOS MANIFENON HAZARr <br /> Ifwaste is asbestos waste, complete Sections I, II, III and IV. No. <br /> 604276It waste is NOT asbestos waste, complete only Sections I, II and ID. <br /> GENE <br /> BATOR <br /> b. Generating Location: <br /> Generator Name: ), r <br /> c. Address: V <br /> - S I e-wM" d. Address: <br /> ' o CG TD to C i TO C DAI <br /> e. Phone No.: Cf, 2-v 4 f. Phone No.: L <br /> owner of the generating facility differs from the generator, provide' " <br /> Owner's Name: h. Owner's Phone No.: <br /> TYPE <br /> r� Containers DM-METAL DRUM " <br /> BFI WASTE. CODE D 3 1 �J DP PLASTIC DRUM <br /> PJ -BAG <br /> fjf A z 142.,0 fl S Sf'J I �- k. Ouantj unite No. TYPE BA -6 MIL. PLASTIC BAG <br /> j. Description of Waste: or WRAP <br /> T -TRUCK <br /> 0 -OTHER <br /> GENERATOR'S CERTIFICATION: I hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Part 261 UNITS <br /> or any applicable state law,fres 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 IC _ 4 <br /> Restrictions,I certify and warrant that the waste haAtrea accordance with the requirements of bo CFR Pari 258 and Is no longer Y3 ,CUBIC ARDSSa h us waste as defined by 40 CFR Part 2&1 O OTHER <br /> enerator Authorized Agent Name Shipment Date <br /> '»: NSPORTER((tan or r5or <br />