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_....IaRL..,,l,,iUS SPECIAL WASTE & ^--°SBESTOS MANIFEST <br /> +f waste Is asbestos waste complete Sections I 11 o f antl fill V N o ,r t I t <br /> i H waste Is NQT_asbestos waste complete only Secnons I Il and III ' <br /> I — ""A GENERATOR (Generator completes all of Section I) <br /> a Gentnr Name o Generating Location <br /> Address d Address <br /> t <br /> I Phone NO f Phone No <br /> f owner of the generating facility differs from the generator provide <br /> I <br /> Owners Name In Owner s Phone No <br /> `17! <br /> TYPE <br /> BFI WASTE CODE I Conlainent DM METAL DRUM I <br /> �1—J LLL���LL��LLLJJJI OP PLASTIC DRUM <br /> B BAG <br /> Description of Waste k Ouanlity glia, No TYPE BA 6 MIL PLASTIC BAG <br /> FIF] [7 T T[ <br /> O OTHER WRAP <br /> GENERATORS CERTIFICATION I hereby certitythat the above named malanai is not a hazardous waste as defined by 40 CFR Part 26T or UN1TS <br /> any applrcabie stale law has been properly described classified and packaged and is in proper Condition for transportation according La P POUNDS <br /> applicable regulations AND If the waste is a treatment residue of a prewousfy restricted hazardous waste sull to the Land Orsposal Y YARDS <br /> Restni I certify and warrant that the waste has peen treated in accordance with the requuemenls of 40 CFR Part 266 and rs no longer a M CUBIC METERS <br /> hazardous waste as defined by 4p GFR Part 261 Y' CUBIC YARDS <br /> d OTHER <br /> Generator Authorized Agent Name Signature Shipment Date <br /> Transpaner I cdmptela e-g <br /> Section ll TRANSPORTER (Generator completea. Trans rteruoom Ietehrl <br /> TRANSPORTERI TRANISPORTERII <br /> i Name h Name <br /> t Address Address <br /> Driver Nameffille l Oriviar Nameil <br /> PRINT T V PF PRINT TYPE <br /> I Phone No a Truck No k Phone No I Truck No <br /> Ucerse No/State m Venicle License No/Slate <br /> vwtedgement of Receipt of Materials Acknowledgement of Receipt of Materials <br /> G - I <br /> n <br /> pnver Skinatute Snipmoni 0,10 3— nvu a Sh nnm Dale <br /> Section III DESTINATION (Generator completes a d destination site completes e I I <br /> a Site Name c Phone No <br />> Physical Address d Mailing Address <br /> Discrepancy Indication Space <br /> I hereby certify that the above named material has been accepted and to the best of my knowledge Irie foregoing Is true and accurate <br /> Name Or AWhonZed Agent Signature r1BrAi01 Date <br /> Section IV ASBESTOS 1Generalor complete aid I g Operator competes e l <br /> a Operators Name b Operator s Phone No <br /> Operator s Address <br /> 7 Special 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 />�3cked marked and labeled and are in ail respects in proper condition for tranSpOrr by highway according to applicable international and government regulations <br /> -�'''�^ <br /> ?aerators Name3Tr'ie <br /> lir ro � � �—� - � Jon i San Grua Jarn <br /> Na^e and Address <br /> 7r RASpi file AgerCr <br /> 'VO^ If:P 29 r ur a Dnin.tL ie <br /> ^5 .-.3s�5 O.�e-� r , r . y P In r na �nvalPa lir mY rte rtn�rt r Jr 0­110r )De-ii. qr❑ u <br /> A 0 THHOULI-,F jAl CONTAAG- TRAM4P0FTFF Yr7 `ilii Q sd o <br />