ARCHIVED REPORTS XR0003447 - Laserfiche WebLink

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ma�yy'. S � .AZAR�.uS SPECIAL WASTE &,i_,dBESTOS MANIFEST 01- If waste is asbestos waste.complete Sections l 11 III and[V N o, 9 0 7 9 0 7 If waste is t�asbestos waste complete only Sections I It and III � GENERATOR (Ganeracor cornpiertes eI of Section z) torName E-5-`ton Cowt)tiny U 5 a1 b Generating Location F,wn '-'t it loo s - )e n218�as ro� � lnatxvn Adwilt Address d Address 1705 t'aufLte4 311, tilt i " Houston TS 77252-2180 5 Loi ! toil CA et Phone No f 713 t 656-7761 1 Phone No ` If owner of the generating facility differs from the generator provide g Owners Name t xNen CuGpuut. L' S A h Owner's Phone No 5 IV, d 1 r' TYPE I BFI WASTE CODE I 0 ' t ' I " f Containers DM METAL DRUM DP PLASTIC DRUM Non BaxardtLua Stitt B BAG j. Description of Waste k Ouanti untie No TYPE BA fi MIL PLASTIC BAG or] 1 , E R-11 1 m T TRUCK O OTHER WRAP GENERATOR S CERTIFICATION i hereby certify that elle above named material is not a hazardous waste as defined by 40 CFR Part 261 or UNITS any applicable State law has been properly described classified and packaged and is in proper condition for transportation according to P POUNDS appllohle regulat ans AND,if the waste is a treatment residue of a prevloueiy restricted hazardous waste suct bleto the Land Disposal Y YARDS Rethfetlans,I Certify and warrant that tile waste tial been treated in accordance with the requirements o1 40 CFR Part 266 and is no longer a M' CUBIC METERS hazerdoue wa aasdalln&dby40CFRPaft261 4i+ ttit lru�r- _t OI EX-L11 uit i, r r + Y3 CUBIC YARDS \ ' e,?inr� O OTHER error W Audxmmed Agent Name J airTB ,l V r I C Shipment Date ANSPORTER Generatorrzmpietea-d T r1h (!align TRANSPORTERI TRANSPORTERII n1113rd Tit-,1(.1119 1 tic a Nanta h Name P �J 8uS 2IS b Address i Address Byron t'1 94514 c Driver Namaliitle uc� 1 Dover Nameffltle ( iU I n31-hfS i0 P4"Tfr)(PE PRiNTfrYPE d Phone No a Truck No i k Phone No I Truck No f !Glia license NoJState 5,_T';—j91c1 7 7 m Vehicle License NoJState wiedgement of Receipt of Materials Acknowledgement of Receipt of Materials onver wee Shoiiint Date Driver mfure shipment Dat. Section III DESTINATION (Generator completes orf uesbnation srto campletes e4) BFTVasLo ltd Landfill ,ill i l a Site Name c Phone No .. 4001 North %asru kvsd 4001 N&J -t h ` l-m o K0.1d b Physical Address d Mailing Address LIVet.%ute CI IttetwasP C1 IGrn e 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 ?OBs 3001- 68 f Pas (19,20lu4 Menne or AU#WW o Agent ssignewre Rena ir!Data Section IV _e ASBESTOS (Genarator complete a-d f g operatue cdmpl.tss ai a Operator's Name to Operators'Phone No c Operators Address d Speuai Handling Instructions and additional information OPERATORS CERTIFtCATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are dassified packed marked and labeled and are in all respects in proper condition for transport by highway according to applicable international and government regulations e Operators Name&Title -i--i- PnnVtype OPerasers signature Dasv I Name and Address P of Responsible Agency g ❑ Fnable ❑ Non friable ❑ Both %friable i nonfnable Operator refers to the Company wnicn owns leases operates controls or supervises the facility being demolished or renovaled or the demoiihon or renovation operation or both *R ONLY THROUGH BFI f UARCO CONTRACT TRANSPORTER RETAIN _ __ © zeo-rsoe—