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`.J <br /> ,ARG---,US SPECIAL WASTE 8, _ 36ESTOS MANIFEST <br /> If waste is asbestos waste complete Sections 1 it 111 and IV �l�0. j "S ) <br /> If waste Is f.Qj asbestos waste complete only Sections; tl and 311 J t G G <br /> GENERATOR (Generator completes all of Sealant) <br /> Orator Name b Generating Location <br /> Address =I t a ' of Address ` <br /> `-- <br /> a Phone No 1 f Phone No <br /> If owner of the generating facility differs from the generator provide <br /> g Owners Name ` i h Owner s Phone No <br /> TYPE <br /> BFI WASTE CODE m Containers DM METAL DRUM <br /> pP PLASTIC DRUM <br /> B SAG <br /> I Descnp[son of Waste x QuantityF , unis No TYPE BA 6 MIL PLASTIC BAG <br /> I�WIhI or WRAP <br /> r T TRUCK <br /> O OTHER <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous waste as deflneo by 40 CFR Part 261 or UNITS <br /> any applicable state Vaw has been properly described classified and paCkageo and is in proper cmdaon for transportation according to P POUNDS <br /> applicable regutabons AND If the waste is a treatment residue of a previously restricted hazardous waste subject to As Land disposal Y YARDS <br /> Restrictions I certify and warrant that the waste has been treated in accordance with the requirements of 40 CFR Part 268 and is no longer a M' CUBIC METERS <br /> hazardous waste as calmed by 40 CFR Part 261 Ya CUBIC YARDS <br /> O OTHER <br /> Generator Authonzed Agent Nre S t.sure _ i9 ri Shipment Date <br /> Section Ii TRANSPORTER Generator complete a4 Tran�s�rter itCOco n 1a to a tom' <br /> TRANSPORTER[ TRANSPORTER 11 <br /> a Name h Name <br /> b Address ' I Address <br /> c Dnver Namemtle r r I Driver Namefritle <br /> PRINTrr1'PE I Plikil l'PE <br /> d Phone No a Truck No k Phone NO I Truck No <br /> f Ie License No 1State .r m Vehicle License No/State <br /> owledgement of Receipt of Materials Acknowledgement of Receipt of Materials <br /> r <br /> g n <br /> Dnver 5 aiuro Stu m Date Dnver Signatum Shp"M pate <br /> Section M DESTINATION (Generator complstea a-d destination site completes a 1 <br /> �r Kit 1 IIJL 1 <br /> a Site Name C Phone No <br /> b Physical Address i d Marling 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 /> fDate� J Receipt Date <br /> coma d Auihonzed A1N^I siRi=rune Recei <br /> Section IV ASBESTOS (Generatorcomptetaad f g Operator comptetese) <br /> a Operators Name b Operators Phone No <br /> c Operators Address <br /> d Special Handling instructions and additional information <br /> OPERATORS CERTIFICATION t hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified <br /> packed marked and labeled and are in ail respects in proper condition for transport by highway according to applicable international and govemment regulations <br /> e Operators Name 8 Tule <br /> PnniJTvi- Operator s Si4neturr Daie <br /> f Name and Address <br /> Ci Responsible Agency <br /> g = Fna01e ❑ Non iriaOle = Both Rrable °y nonlnable <br /> Operator refers to the Company which owns eases operates Conirbls w—Pervises the t lcmty being aernoushed or r—nvaled or the dem—tin,or renovdiwn oporaWn or Win <br /> Qan r nn i <br /> 4*R ONLY THROUGH$FI UARCO CONTRACT l i;/,f 4;1301R TFH _�ETAIN <br />