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;ee. <br /> _ecARD%wLIS SPECIAL WASTE & ,,,-3BESTOS MANIFEST <br /> N waste!s asbestos waste complete Sections I it III and IV No 9',' <br /> sl waste is UT.asbestos waste complete only Sections 1 11 and III <br /> GENERATOR (Generator completes all of Section q <br /> Generator Name o Generating Location <br /> I LI _ <br /> Address a - d Address <br /> )r i T <br /> Phone No ^t _ t Phone No <br /> owner of the generating facility differs from the generator provide <br /> Owner's Name h Owners Phone No <br /> TYPE <br /> SFI WASTE CODE EDI I I � � il I � I I IT Containers DM METAL DRUM <br /> DP PLASTIC DRUM I <br /> B BAG 1 <br /> Description of Waste k Quantity Units No TYPE BA 6 MIL PLASTIC BAG <br /> or WRAP <br /> T TRUCK <br /> O OTHER <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material Is not a hazardous waste as defined by 40 CFR Part 261 or UNIT <br /> any applicable state law has been property descnhed CIaSSihed and packaged and Is In proper condition for transponation according to P POUNDS <br /> appiicable regulations AND It the waste is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Y YARDS <br /> ResinCdOns I certify and warrant that the waste has been treated In accordance with the requirements at 40 CFR Part 268 and is no longer a M CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261 I Y' CUBIC YARDS <br /> O OTHER <br /> Generator Auihonzed Agent Nadia rSignatura Shipment Dale <br /> Transporter[r�mplete e•g <br /> 3eCtion II TRANSPORTER Generator complete a-d Tran ner 11 com ate h-n) <br /> TRANSPORTER I TRANSPORTER U <br /> I Name I tl r ` r- I <br /> h Name <br /> I Address I Address <br /> Driver Name/Title - `� 1 Driver Name/Title <br /> PR1NTrrvPE PRINT/rYPE <br /> I P a No a Truck No k Phone No I Truck No <br /> Ucensa NolState —If m Vehicle License No!State <br /> A howledgement Of Receipt Of Matenais Acknowledgement of Receipt of Materials <br /> n <br /> 02var 5 Iwe —' Sh-prnerri Oat. ❑neer S lure Shy inmT Dale <br /> Section III DESTINAMN (Generator compietee a-d destination site completes a-1) <br /> r <br /> t Site Name c Phone No <br /> t Physical Address d Mailing Address <br /> t 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 /> Name ar A,Mrz-1 Agent W.I— Necalpl Date <br /> Section IV ASBESTOS (Generatorcornpsete a-d t g operator cornpietes e) <br /> t Operators Name b Operators Phone No <br /> Operator s Address <br /> j Special Handling Instructions and additional information <br /> OPERATORS CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified <br /> lacked marked and labeled and are in all respects in proper condition for transport by highway according to applicable ntematioral and government reguflaauonnss <br /> Operators Name&Title <br /> P nir ee Jnerators Sgnamre Date <br /> Name and Address <br /> of Responsible Agency <br /> 3 :� Friable Non trlabte L— Both °,friable °r°nontrlable <br /> O1pr e1pr5rpma company sr[:n owns Pa sea Operates cartr0ls ]r,v oerv�5esthetaCllily tlPrng apmehshea Or rrllnvateu ur fiiC tlemphtlDl OI renevatiOn Oper loon o Oraih <br /> R ONLY THROUGH SFI JARCO CONTRACT Q �°raun <br />