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FP0i-i : 0 PHONE 110. , 209 9P1 9153 0 T..t 1. 01 1959 Oy: 11:F=H F'4
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<br /> NON-HAZARDObrS'SPECIAL WASTE & A�ESTOS MANIFEST
<br /> If waste is asbestos waste,complete Sections I.H.IF(and TV. N O. 3��+�
<br /> 3
<br /> N wa6te is NOT asbestos wicv..complete only Sections 1.L and ilio
<br /> -i w:Ri -I"t .Yr^ ti«: r `�'1'- "rrjE_RE.fiA�'�• �'.m•�v Aw ,,y�r� - - I
<br /> • It©O F'�e''�..._ � nSAtRb aofni+lelea `�-sYl ' �r'b r n
<br /> MODLK`TS --rI kPANV b. Generating Location: ARCO STAI-Wt> 904997^
<br /> a. Generator Name:
<br /> c. Address F0H 5077 d. Address: +� E. siARPIt:m
<br /> EUEMs PAILY:f C$
<br /> (975) 299—£;.91 ?7,'JL B[3R'PL8 ' idjA.
<br /> a. Phone No.: • t. Phone No.;
<br /> If owner of me generating facility differs from the generator.provide:
<br /> LRC'_l, IrRO?776""iS �.A 'A.'YY cgy1g ns i tc 1
<br /> g. Owners Name: h. Owners Phone No.;
<br /> DM-METAL DRUM
<br /> FRP DEE
<br /> c r a cis 1 7 0 2 t
<br /> I. 6FI WASTE CODE ContainersTYPE DP -PLASTIC DRUM
<br /> t30e1—Ii;�_713yRIX0i vz_YIL B -BAG
<br /> j. Description of waste: k. Quanll� orin No
<br /> m BA -6 MIL. PLASTIC BAG
<br /> or WRAP
<br /> 7 O U Y 0 1 2 T -TRUCK
<br /> O •OTHER
<br /> GENERATOR'S CERTIFICATION: I hereby cartify that the atw.e named material is run a hazartrrnu—aste as aftlined by up CPR Pan tet or UNITS.
<br /> any applicable state low, has been Properly deecrtbad, dassired AM packapacl, aM is in proper crmdhlon for,ransyoitaniun acca'ding to P -POUN
<br /> stDS
<br /> applicable regulations:AND,if the waste ie a treatment residue of a previously rerlct tmaardous waste subject to the Lard Disposal Y -YARDS
<br /> Restrictions.I cerrily and warrant that the waste has been treated in accordance wNh tt,6 regubE r,r;nta o14e CFR Pan 2M and ir.nn -CUBIC METERS
<br /> hazardous waste as defined by a0 CFR Part 261. YT ..
<br /> _ he L^4`.¢_]s31rL•,.A]" jK'tlY: 3l5;! }:?M$ r.:k•?r y Y' -CUBIC YARDS
<br /> iu.2_gSA X2:Ru/ 1'?L73.P.t3 !• Y O -OTHER
<br /> Mii y
<br /> Gareralor Ard6ndzad Agent Name $ignahae r - Shipment Dais
<br /> -.
<br /> .. Nt'J.rd d..1. ..u2',.Wi�•. !N.T..aQ.fr14F.FiFi..' tela.tlNT
<br /> TRANSPORTER I TRANSPORTER U
<br /> a. Name: It. Name:
<br /> b. Address :. / >z> '-o".f/1 �., '. . . . , _.._--' . G_.�;r. I. Address:
<br /> v
<br /> i. Diivei�art,a,?ide _ _ -�'. `f: :'.d�.;•t:A=.t j. Driver Names?ftla:
<br /> PPINTINpE PRINTITYPE '
<br /> d. Phone No.: _ a. Truck No.: k. Phone No.: 1. Truck No,:
<br /> f. Vehicle License No./State: a-�.'+b i l:.'?' G. m.Vehicle License No./State:
<br /> Acknowledgement of Receipt of Materials. Acknowledgement of Receipt of Materials.
<br /> om.. � �`.. -- SN pme Cei.er s' snicmeru Prue
<br /> SEft1Q,F1 ,�[ ;: ,VY'"va,Y�c.fiy '� tl tM V :::, C�,��)[`l'.�.Tr�.f,�ayry6erJ.esatofssdglptetw�+dgdami"atwo-snasompjatesat.l -
<br /> BPI - V$SCO Ea3AD S%wrrARY I.t,WTQPS'S.S. 2925) 447-0491
<br /> a. Site Name:�_ Phone No.:
<br /> 7'v--1 cY. t.'?b:=:Ct.` TtaYAC• '4+701 c `J»SCO ROAD
<br /> It. Physical Address: d. Mailing Address
<br /> LIVIC01013Re ae;u:5i;.. LIV'mx-AR.F:, C7a 9455u
<br /> a. Discrepancy Indication Space:
<br /> 1 hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate.
<br /> J'CS3A IUO7-'Ll'N
<br /> I. ..:
<br /> '{� ....... _. PO® 1}9-303013
<br /> Hans M Au[ItayalO gts�n slanamre Rapifn Date
<br /> :Section ry ._: - ASBESTOS- ar at.Pt°r r?Il`IEsYe�eai.. ate'„' jP(ittat"a l• I+,^ ,x" �I:^^e'I ,,,us ':
<br /> a.. Shippe'vs-Name: b. Shippers's'Plane No.:
<br /> C. Shipperri Adore":
<br /> d. Shippers'5 Special Handling Instructions and additional information'.
<br /> CERTIFICATION: I hereby declare that lite contents of thio consignmeul era fully autl accurately described above Uy grope, .bippi i, nam. and are tlaebAied.9anAeyer
<br /> mall,",and and are in all respects in prnper condition for transport according to applicable trnerr,arion,l and ri;nonal governmental regulations.
<br /> e. Shippers's• Name&Title:
<br /> r+Nrnrrroo Snios�,- s,.y�.,..,� ti.
<br /> f. Name and Address
<br /> of Responsible Agency:
<br /> 9 CI Friyble: ❑ Nolf4riable: U Both %friable Is nonlriable
<br /> e ChiPpw r.lera to[ha company which owns.lames.uver.t.. xnlrols.or..orr,is.s the tacllity being demolished or rcoo•at d.of the demolition or rar,ovation o,,aretirm.x tart,
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