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.40N•HAZARC-'US SPECIAL WASTE & --313ESTOS MANIFEST <br /> 1waste s asbestos waste complete Sections I II III and tti {O rr (, <br /> It waste is NOT asbestos waste complete only Sections 1 {I and 111 <br /> 1r <br /> Section I GENERATOR (Generator completes all of Section I) <br /> I -tor Name b Generating Location <br /> Address d Address <br /> I Phone No t Phone No <br /> f owner of the generating facility ditfers from the generator provide <br /> Cwner s Name h Owner s Phone No <br /> m TYPE <br /> BFI WASTE CODE Containers DM METAL DRUM <br /> DP PLASTIG DRUM <br /> B SAG <br /> Description of Waste k Quantity units No TYPE BA 6 MIL PLASTIC BAG <br /> or <br /> rr l m O OTHER T TRU <br /> WRAP <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material s not a hazardous waste as defined ny 40 CFR Pan 261 or UNIT <br /> an d eCabl9 slate law has been properly described classiheo and packaged aria i5 n i <br /> Y PP p P y g � Proper condition far transportation according co P POUNDS <br /> appluable regulatici AND If the waste is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Y YARDS <br /> Restrictions I cemfy and warrant that the waste has been treated in aCCordance with the requirements of 40 CFR Pan 268 and is no longer a M CUBIC METERS <br /> naxaraoua waste as defined by 40 CFR Pan 261 Y' CUBIC YARDS <br /> F� - �O ._OTHER � <br /> Generator Authorized Agent Name Sgyglturay _ / ,, Shipment Date <br /> Section II TRANSPORTER Generattor compiete ad, Tia=rdtee�ii c m°I etc n�-n) <br /> TRANSPORTERI TRANSPORT1=R11 <br /> I` .] S 1 r <br /> I Name h Name <br /> F � ` <br /> Address I Address <br /> Driver Nameffitle , I Driver Name/Title <br /> PRINTrTYPE PF1iNTrf1'PF <br /> J Phone No a Truck No k Phone No I Truck No <br /> Vehicle License No iSlate i m Vehicle License No/Stale <br /> orwledgement of Receipt of Materials Acknowledgement of Receipt of Materials <br /> ]r^ei 5 eturo Sh orrt Date Onver S lure Sh,firriti bate <br /> S@CIiOD III DESTINATION (Generator completes a-d destination site completes 9-f) <br /> I Site Name c Phone No <br /> Physical Address d Mailing Address <br /> s Discrepancy Indication Space <br /> I hereby ceii that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> > � 1 f <br /> Name d AIrGlOnzeo Agent Signature Receipt bate <br /> Section IV ASBESTOS (Generatorcompletea-d I g Operator compieteae) <br /> a Operator's Name b Operators Phone No <br /> Operator s Address <br /> 1 Special Handling instructions and additional Information <br /> OPERATORS CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately descnbed above by proper shipping name and are classified <br />]acked marked and labeled and are in all respects in proper condition for transport by highway according to applicable international and government regulations <br /> `.}aerator$ Name 8 Title <br /> m Type Operamr s Signalure Dare <br /> .a—e and Address <br /> 73 gespons Die Agency <br /> 3 _ =sable _ fid^ 'nab�e _ Both friable oa nonfrabie <br /> '`2;for P=s to the omoan r„n cn vn, P]SLs ipe i s o n s p�v ses Inv f-1 dd tit rq Demul,W%ed tr aniovMod lh, lo-oirtion or renovation operation or boli, <br />,j*ONL'-HIPOUGH E3F1 UARCO CCNTPAC7 7 i �pr��TCF O L60 2JB <br />