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NOWHAZARD,aUS SPECIAL WASTE &'. SBESTOS MANIFEST <br /> II waste is asbestos waste complete Sections 111 Ill and I� No 3 0 7 u L.Aga . <br /> If waste Is NOT asbestos waste complete only Sections I sl antl III <br /> .S7 oft I GENERATOR (Generator completes all or Section Il <br /> a rater Name b Generating Location <br /> s_r _ <br /> c Address I d Address ' <br /> e Phone No f Phone No <br /> If owner of the generating facility differs from the generator provide <br /> g Owners Name i <br /> h Owner 5 Phone NO <br /> TYPE <br /> BFI WASTE CODE m Containers DM METAL DRUM <br /> DP PLASTIC DRUM <br /> B BAG <br /> 1 Description of Waste x Quarility Units No TYPE BA 6 MIL PLASTIC BAG <br /> Or WRAP <br /> T TRUCK <br /> O OTHER <br /> GENERATOR S CERTIFICATION i herady certify that the above nameo material s not a hazardous waste as defined by 40 CFR Part 261 or QNIT,$ <br /> any applicable state law nas been properly aescnbea classified and packaged and is in proper condition for transportation according to P POUNDS <br /> appircawe regulations AND if the waste Is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Y YARDS <br /> Restnations I certify and warrant that the waste has been Ireated in accordance with the requirements of 40 CFR Part 268 and is no longer a M CUHIC METERS <br /> hazardous waste as defined by 40 CFR Part 261 Y] CUBIC YARDS <br /> O OTHER <br /> Generator Authorized Agent Name y nature Shipment pate <br /> Section Trans(]pner f complete ei <br /> TRANSPORTER (Generator complete ae Trans er a coin efe h-n } <br /> TRANSPORTER] TRANSPORTERII <br /> ^til ~ i � III <br /> a Name h Name <br /> b Address I Address <br /> C Driver Nameffrtfe Driver NamelTlUe <br /> PRINTTYPE PRINTTYPE _ <br /> d Phone No a Truck No a Phone No I Truck No <br /> I*I* <br /> +cls License No/slate m Vehicle License No/State <br /> owledgement of Receipt of Materials Acknowledgement of Receipt of Materials <br /> Is License No/State <br /> � n <br /> D.—Signature '22 r,DtIa _ 7mar s':i-lurr <br /> Shipment Oate <br /> Section III DESTINATION (Generator completes ad destination sste completes a f) <br /> a Site Name c Phone No <br /> b Physical Address d Mailing Address <br /> e Discrepancy indication Space <br /> I hereby certify that the a0i named material has been accepted and to the best of my knowledge the foregoing Is true and accurate <br /> +flame or Auttwonzed Agent Signature Raceipt Date <br /> Section IV ASBESTOS (Generator oompfete a�d f g Operator completes e( <br /> a Operators Name o Operator s Phone No <br /> c Operator s Address <br /> d Special Handling Instructions and additional Information <br /> OPERATORS CERTIFICATION I hereby declare mat the contents of tits consignment are Iuuv and accurately desenbed above by proper shipping name and are classified <br /> packed marked and labeled and are m an respects to proper condition for transport by nignway according to applicable cnternatlenal and government regulations <br /> e Operators Name&Thle I <br /> P iMl oe dpe aiers Sgnarur+ ,Jve <br /> I Name and Address <br /> of Responsible Agency <br /> q _ Friable : Non friable Both c inabie nortr able <br /> opergi0 r"P 5 a the^ompary whirr,o rS eases or,9 e5 ]r s .roc v 5es P [F^7 o i-ri or renpvnlPd r hp ie,nom,on rr t novation uperit on .r poi <br /> R ONLY THROUGH gFi UARCO CONTRACT TRANSPORTER RET AIN O -60 T2pa �7 <br />