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*• <br /> NON HAZARD S II CIAL WASTE & � BESTO <br /> s + # . <br /> ' - S MANIFEST -,-..... <br /> If waste Is asbestos waste. complete Sections I,sAR H,M text IV:, Ind. '604277 k <br /> If waste is NOT asbestos waste, complete only Sections T, Q and M. <br /> knerator <br /> on I._ GENERATOR (aName: —FW -F-.L ��4.� b. Generating Location: <br /> Address: 0 Z� d. Address: �sf ► YL°-�U�,v D�r� <br /> —7-0 C K'-ro ri <br /> 1I1Phone No.: q 1 b 9 72, t{ d f. Phone No.: <br /> wner of the generating facility differs from the generator, provide: <br /> g. Owner's Name: h. Owner's Phone No.: <br /> TYPE <br /> -1I3F1 WASTE CODE ( Z Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> r B -SAG <br /> j Description of Waste: �ZU OU S SD l�— k. Quantity Unft No. TYPE BA -6 MIL. PLASTIC BAG <br /> or WRAP <br /> �ry T -TRUCK <br /> (J O -OTHER <br /> CERTIFICATION: I hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Part 261 UNITS <br /> ,GENERATOR'S <br /> any applicable state law,has been properly described,classified and packaged,and is in proper condition for transportation according to P -POUNDS <br /> plicable 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 treats coordance 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. t Y3 -CUBIC YARDS <br /> O OTHER <br /> enerator Authorized Agent Name. ature Shipment Date <br /> ction .i �'? r z_<, ; rranapcuter I'oompttle e.y <br /> y'iAANSPQFtTEA�C�erterasor'°'bornplate a-0: l`ranel9arter 8 oornpte:e tt-n} .,.. <br /> T}RANSPORTEERR`Ip �� h TRANSPORTER II <br /> a. Name: '.� LL D f �-'�C'�t h. Name: <br /> U <br /> Odress: � - e, ZP, ssk I. Address: <br /> Driver Name/Title: - --- }.- Driv9Lt4Arg9/Title; <br /> �J RINTITYPE ,;f ,:, PRINT/TYPE <br /> a. Phone No.: 1 Y ©1 e. Truck No. _ � k. Phone No.: 1. Truck No.: <br /> Vehicle LicensID./State: m.Vehicle License No./Slate: <br /> Acknowled nt of Receipt of star' Is. Acknowledgement of Receipt of Materials. <br /> O1 d7'1 <br /> . • n <br /> Driver Signature Shipment Date Dnver signature Shioment Date <br /> CtiQn III NATJON {Generator cornptetes eo-d,��atidtsslte e f <br /> 3 <br /> �7 f <br /> Site Name: A N �L'c. Phone No.: ISM S` { /�J 19� <br /> thysical Address: _/Y , r d. Mailing Address: <br /> Ll <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 /> Name of Authorized Agent Signature Receipt Dale <br /> ctlon rV ASBESTOS (Generator complete a-d;t q,bperator" <br /> completes e-) <br /> fperator's. Name: b. Operator's' Phone No.: <br /> perator'st Address; <br /> 1pecial Handling Instructions and additional information: <br /> OPERATOR'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 /> F eked, marked, and labeled, and are in all respects m proper cgndition for transport by highway accgrding to applicable international and ggvernment regulations. <br /> e7Lperator's* Name & Title: <br /> PrintfTvoe -- - --._ - <br />