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US SPECIAL WASTE & -_.3BESTQS MANIFEST <br /> It waste,s asbestos waste complete Sections lit Wand Iv <br /> It waste is t• T asbestos waste complete only Sections I It and III �Q� 907913 <br /> S n GENERATOR [Generator comptetes all of 5ort,on <br /> n <br /> t atorName <br /> _ b Generating Location 'I+ ' ti <br /> Address '-fl .'.13135 �II _ Lb_Jn t or <br /> tl Address r,t <br /> J �I9 <br /> Y Iti <br /> Phone No - <br /> owner of theeneratmn I Phone No <br /> g 9 facility dltters from the generator provide <br /> Owners Name " <br /> h Owner s Phone No " <br /> BFI WASTE CODE71 = = TYPE <br /> Containers DM METAL DRUM <br /> Description of Waste �Oil ft _,L a" DP PLASTIC DRUMI <br /> B BAG <br /> k Quantity Unas No TYPE BA 6 MIL PLASTIC BAG <br /> or WRAP <br /> J I mT TRUCK <br /> GENERATOR S CERTIFICATION O OTHER <br /> I hereby csrtrfy that the above named material is not a hazardous waste as defined by 4D CFA Part 261 or <br /> any applicable state taw has been properly described classified and packaged and Is m proper condition for transportation accordin to UNITS <br /> applicable <br /> regulations <br /> floe ty'and warrant that the If the.waste I*aweatreatment has been ealiftie d Iataccord Previously <br /> restricted hazardous waste sublect fo the Lend Disposal P POUNDS <br /> hazaMus waste as dented bnce requirements of 40 CFR Part 268 and s no longer a Mr YARDS <br /> _ Y 40 CFR Part 261 � It t F� n , a CUBIC METERS <br /> Y CUBIC YARDS <br /> O OTHER <br /> Generator Authormzed Agent Nant <br /> Shipment Date <br /> 3ctlDn II TRANSPORTET,3enftaoP1ft TRANSPORTER! <br /> !lard T1,I(krllti i.1, TRANSPORTER11 <br /> NameAddresss]aver NamelTitle <br /> Name/Trtle'hone No aG }t ,,, -rl RI urmPEe Truck No PRiNMYPENo I Truck No <br /> 1 Cense No!State r � <br /> dganlent of Rlacelpt of In m Vehicle L,conse NolState <br /> Acknowledgement of Receipt of Matenals <br /> rhrer 5 naa,ie n <br /> 9hlt Dau Driver S nattue <br /> Coon DESTINATION tGeAerator <br /> E ` oom etaa a-d,destnayon alta completes e•f <br /> shi rhar,t pde <br /> ite Name E1FI , s, i <br /> c Phone No <br /> hysical Address it t id <br /> d Mailing Address <br /> iscrepanayIndication Space <br /> lerebY cerbty that the above named matenal has been accepted and to the best of my knowledge the foregoing is true and accurate <br />—01—A Sgnaane = PO -9 <br /> Racalpt Date <br /> tron IV ASBESTOS tGenerator'Omplete a<f f <br /> g Operator'completes e <br />)eratl Name <br /> b Operators Phone No <br />,eratols'Address <br /> ectal Handling Instructions and additional Information <br /> tATORS Cf RTiFICATiON I hereby declare that the contents of this consignment are fully and accurately described above by proper sh,ppmg name and ars crassdled <br /> I marked and labeled and are m alt respects m proper condition for transport by highway according to applicable international and government rename ns <br /> erator's Name S Title Ir I Imo' I I y' <br /> Pnnf/rypeJ <br /> me and Address oV"alor s aignaNre bare <br /> 3esponsible Agency <br /> Friable Lr__j Non friable ❑ Both <br /> °�,friable ,nonfnable <br />-raldr refers to the company which owns teases oAefates Controls or supervises the facility being demolished or renovated or the demohllon of renovahon operation or both <br /> EOHROUGH 13FI 1 UARCO CONTRACT <br /> TRANSPORTER RETAIN © zso rzoa ses <br />