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.AZARL-.,US SPECIAL WASTE & -SBESTOS MANIFEST <br /> If waste es asbestos waslei complete Sections I II FII and 14 I <br /> u waste cis I�QT asbestos waste complete only Sections I I f ana III No. <br /> _ L ' <br /> 1 GENERATOR (Generator completes all of Section t)erafor Name b Generating Location —--- <br /> c Address d Address <br /> e Phone No t Phone No <br /> 11 owner o1 the generating factitty'lifters from the generator provide <br /> g Owners Name <br /> M Owner s Phone No <br /> m <br /> TYPE WASTE CODE Containers QM METAL DRUrrI <br /> OP PLASTIC DRUM <br /> B BAG <br /> Quan <br /> I Description of Waste K ( tity IffU. <br /> -ts�,! No TYPE �BA 6 MIL PLASTIC BAG <br /> or <br /> R WRAP <br /> T TRUCK <br /> O OTHER <br /> GENERATOR S CERTtFICATION I heretyy certify I1181 the above named matenai is not a hazardous waste as defined by 40 CFR Part 26,or NIT <br /> any applicable stale law has been properly descnbea classified and packaged and is in proper condition for transportation according to P POUNDS <br /> applicable ragujateons AND if the waste Is a treatment residue of a previously restricted hazardous waste subject to the Lanaptsposat Y YARDS <br /> art 268 and-s no longer a M, CUBIC METERS <br /> Restrictionscertify and warrant that the waste nas seen trearea-n accordance with the requirements of 40 CFR Pl <br /> 4azaraous waste as defined by 40 GFR Part 261 Y' CUBIC YARDS <br /> O OTHER <br /> Generator Authorized Agent Name Signature Shipment pale <br /> I <br /> Secifpfl II TRANSPORTERGeneratortAmplatea-d Transporter 1facom%Igteh9 ) <br /> TRANSPORTER[ TRANSPORTERtt <br /> a Name h Name <br /> b Address I Address <br /> c Driver Name/Title I Driver Name/TitlePRINTfTV PE PgINTRyPE <br /> d Phone No a Truck No k Phone No l Truck No <br /> P Vehicle License No/State m Vehicle License No/State <br /> 0owledgement of Receipt of Materials Acknowledgement of Receipt Of Materials <br /> n <br /> 0-ry Se awe ship—Date Dnvar S-narure <br /> sh nr 03 e <br /> Section III DESTINATION (Generator completes a d destination site completes e i) <br /> a Site Name C Phone No <br /> b Physical Address d Mailing Address <br /> R 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 /> I1:1ITT1 -7 <br /> dame or awhonzed Agenr SK]namre Receipt Date <br /> Section IV ASBESTOS (Generator complete aid f g Operator Completes e) <br /> a Operators Name b Operalors Phone No <br /> Operator s Address <br /> a Special Handling InSrrutions and additional information <br /> OPERATOR 5 CERTIFICATION I hereby deciare that the contents of tins consignment are fully and accurately described above by proper shipping name and are=assilwcj <br /> lacked marked and labeled and are in all respects in proper rondeteon Ion transport by highway arrorrlinq to apparablp Inlern3teonal ind qcm rnrllpni regul9-ono <br /> Operator s Name&T t e ILF—r���''�^� <br /> r nu'Type opera-or s S-gnamre r, <br /> *lame and Address <br /> of Responsible Agency <br /> a ❑nable _ Non treabie ^ Both o II abie o nonfnabie <br /> 7eeralor"eters to me cmpany wricn owns ieases abar itee cornrc s r sup.r,Sys ne-a� r Doing,7—..sped or rennvat"i o no 0-01.10.or a^ovaw,r D—i- <br />-0 Lr THROUGH BFi UARCC CONTRACT _1;HNSP0RTER RETAIN © ' 6 <br />