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NON-HAZAR"S SPECIAL WASTE & L.�BESTOS MANIFEST <br /> If waste Is asbestos waste complete Sections I it [[i and IV Noe 3 0 T 6 3 5 <br /> If waste is b QQ asbestos waste complete only Sections l 11 and 111 <br /> GENERATOR tGenerator completes all m Sectio,n <br /> rc tet, <br /> 3eneratorName t- EUII CrJjspdn� 5 b Generating Location <br /> ti , <br /> ri tIg P ,ot1'1L.1oil .+u.iiiI, �^+ �rilfhI l4 41 Ri.r' <br /> 4ddresa I8 � r d Address <br /> Hou.+ori T1 77252-2i8� <br /> Phone No <br /> f Phone No ti <br /> wrier of the generating facility differs from the generator provide <br /> 1 f <br /> Owner's Name EhYr,it Comp-11i ` h Owner's Phone No TYP£ <br /> = E= <br /> i 'r Containers DM METAL DRUM <br /> BFI WASTE CODEM, DP PLASTIC DRUM <br /> B BAG <br /> Urvts No TYPE BA S MIL PLASTIC BAG <br /> Description of Waste tiOri ;I3' t tluua 5D i ' k na <br /> or WRAP <br /> t m T TRUCK <br /> O OTHER <br /> GENERATOR S CERTIFICATION I hereby terury that the above named material is not a haurdOuaDwBia�sl9 n oe1 transportation�rdin9 to P P UNDSi <br /> any applicaNe state taw has been properly described dassihad and packaged and is in props <br /> appticaple regulations AND IT the waste is s treatment residue of a previously restricted hazardous waste subject to the Wnd Disposal Y YARDS <br /> Resinot,ng t Certfy and warrant that the waste has been treated m accordance with the repuiremenU o1 40 CFR Part 28a and is no longer a Y' CUBIC YMARDSS <br /> n <br /> hazardous waste asdefined by40CFR Pan 281 nL the reclttt-t ui c't` iu CJpitt,t't I O OTHER <br /> yaA�E` I *�.k - t �`on i _ Shipment Date <br /> Generator Auihbnzed Agent Na" Tp rs n+1 t w <br /> Transporter 1 carnPlete s-g <br /> Section II TRANSPORTER Generator complete a� Trans nen n 1}+i <br /> TRANSPORTRRI <br /> TRANSPOR7ER1I <br /> Dtllar,l Trtlrittng Ini h Name <br /> I Name <br /> P O Duv 313 Address <br /> i Address <br /> B%ti,u CA tJ45I-I <br /> Driver NameTtle PRINr/r PE <br /> Driver Namerritle --LI pRIN7/iYPE <br /> ("10) '114-63,313 <br /> 34-6 3513 ' k Phone No <br /> 9 Phone No a Truck No I Truck No <br /> fa License NodState �„<1 1l � m Vehicle License NoJState <br /> 'Wowled(g�ament of Receipt of Materials t Acknowledgement of Receipt of Materials <br /> { I l n 5h merit Dale <br /> g shi -I Dasa Drner 5i naw e <br /> Dmrer s lure <br /> Section III I?ESTINATION (Generator completes a-0 destination age complelas 44) <br /> I;IOi ' 17-11;11 <br /> Bel Vrisru Rd Laud f,' 3 c Phone No <br /> a. Site Name 30G. Vr,tCtt t 1'.l,o hu.iu <br /> 4001rv+�ltkl IASCo T.Ud1 d MarllngAddress <br /> b Physical Address L i vryrwu r o 1 94110 <br /> Li vet mol e Cl 94:f 110 <br /> a Discrepancy Indication Space <br /> I hereby certify that the above named material has been sc ti pted�o the best of my knowledge the foregoing Is true and accurate <br /> 10134 2002 <br /> FOTLpor 09-20i41 <br /> f � Receipt Dots <br /> Nim.at wawrizw A9-ht <br /> Sectton IV ASBESTOS (Generatoroomplete" t ;operator"mimes-I <br /> a Operators Name b Operators Phone No <br /> c Operators'Address <br /> d Special Handling Instructions and addttionai Information <br /> OPERATORS CERTIFICATION I hereby declare that the contents of this cons+gnmenl are fully anQ accurately described above by proper shippingrvi:r name and areclassified <br /> packed marked and labeled and are in all respects In pibper condition for transport by highway according to applicable internetfanal and govemmem ragulabonl�-�--u--�--� <br /> a Operators Name&Title Dperamrc svewe <br /> D.+e <br /> PrmilTyps <br /> f Name and Address <br /> of Responsible Agency <br /> ❑ %lnable %nonlnable <br /> g ❑ FriableNon fnat7le ❑ Bath <br /> Operator refers to the company which owns Teases operates controls or sup f+sae the facility bang demolished or renovated or the demolition or renovation aper®n or both <br /> 4 $fA720e 497 <br /> DER ONLY THROUGH i3FI1 UARCO CONTRACT TRANSPORTER REMAIN <br />