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-e,sUS SPECIAL WASTE & —.aBESTOS MANIFEST <br /> ff was <br /> is asbestos waste complete Sections t II 111 and IV No. 7 <br /> S1 waste iS�asbestos waste complete only Sections 1 II and[[[ ��I <br /> On I GENERATOR (G9neraford4;mpfete5 all of Section i) <br /> a Generator Name b Generating Location <br /> Address d Address <br /> 3 Phone No f Phone No <br /> I owner of the generating facility differs from the generator provide <br /> Owners Name " n Owners Phone No <br /> TYPE <br /> Containers DM METAL DRUM ! <br /> SFI WASTE CODE m OP PLASTIC DRUM <br /> FT= F�= B BAG <br /> Description of Waste x Quann uBA 6 MIL PLASTIC BAG <br /> or WRAP <br /> T TRUCK <br /> M [1 O OTHER_J <br /> GENERATOR S CERTIFICATION I hereby certify that the above nameo malenal is not a hazardous waste as defined by 40 CFR Part 261 or UNITS <br /> any applicable state law has been properly described Classdieo and packaged and is n proper condition for transportation according to P POUNDS i <br /> applicable 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 treated in accordance with the requirements of 40 GFR Part 268 and is no longer a M, CUBIC METERS <br /> hazardous waste as defined by 40 CFA Part 261 Y' CUBIC YARDS <br /> Q OTHER <br /> �JA- lit- - r <br /> r <br /> d A <br /> Generator Authorized Name SgnafpreL- _ - r At Shipment Data <br /> Transporter I complete ey <br /> Section II TRANSPORTER (Generator complete a-d Transportaril cam lets h n <br /> TRANSPORTER[ TRANSPORTER[[ <br /> t - h Name <br /> a Name <br /> to Address i Address <br /> c Driver Name/Title Onver Name/Title <br /> PRINTrTV PF <br /> pRiNI'MrK <br /> 0eO a Truck NO x Phone No I Truck No <br /> 1h,'Cle"Llrense No/State m Vehicle License No(State <br /> Acknowledgement of Receipt of Materials Acknowledgement of Receipt of Materials <br /> gn <br /> prover S awse <br /> SNynmi pate Dnvm Si k wre Sm mese pale <br /> Section III DESTINATION (Generator completes ad destination sue completes e f I <br /> r <br /> a Sfte Name c Phone No <br /> b Physical Address d Mailing Address <br /> e 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 /> I Name of AusonZOe Ageni Signature fleceipt pate r <br /> Section IV ASBESTOS lGenerator complete ad f g Operator comptates e, <br /> a Operators Name b Operator s Phone No <br /> c Operator s Address <br /> d Special Handling Instructions and additional informahor <br /> OPERATORS CERTIFICATION I hereby declare that the contents of this consignment are Iuily and accurately desdhbed above by proper shipping name and are GlassiliPd <br /> packed marked and labeled and are fn all respects in proper condition[or transport by highway according to applicahle fnternabonai and government regulaconss � <br /> e Operators Narre&Td1e opera iorsSignmuee <br /> P nLTvoe <br /> f Name and Address <br /> of Responsible Agency <br /> g _ Frable ,_. Non triable Both 'a friable °o nonfnable <br /> eraSor refers m the corrmpary wnich owns leabes ope ales c,oniro S Or Supervises the fac,Ply bent)demolished or renovated or the demons C11 ur renov i nn op ritior or r <br /> Q 'bq r,r3 <br /> tiu ORDER ONLY THROUGH BFI UARCOCONTRACT .R t�i'PQR i.:R rdETAIN <br />