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S SPECIAL WASTE & , SBESTOS MANIFEST <br /> If waste is asbestos waste complete Sections[ [I [II and IV No. 0 Z O <br /> If waste is NOT asbestos waste complete only Sections[ [I and f[1 <br /> GENERATOR (Ganeratorcompletaaa crSecbonl) <br /> Generator Name C 4 tan r'^iat�3[1', U '; ,1 b Genera[Ing Location E I.ii <br /> 1 � SJR 111ati kdri,ti <br /> Address Y.y3 ` 8 nas w aJ�r7, tl Address -�'r Cntliit, "'tut i51 i <br /> Houston TX 77d52-21RU 9torkt<u, r <br /> Phone No 1 71 3) it 3C� i 6 3 I Phone No ` l <br /> owner of the generating facility differs tram the generator provide <br /> Owner's Name t,,v1, vtoo tint I S .t h Owner's Phone No <br /> BFI WASTE CODEE] I f) 0 4 ' i ) i 1 7 Containers DM METAL O UM <br /> DP-PLASTIC DRUM <br /> L-SAG <br /> Description of waste Non fl,2ardoua Sul l k Ouant tuw No TYPE 6 MIL.PLASTIC BAG <br /> / 0 lir WRAP <br /> [ I I I T T TRUCK <br /> O OTHER <br /> GENERATOR S CEFMFICAT[ON I hereby cantly that the above named material is not a hazardous waste as defined by 40 CFR Pan 281 or UNITS <br /> any apoficable state law has been property described classified and packaged and is in proper condition for transportation according to P POUNDS <br /> apoicable regulations AND M the waste is a treatment residua M a previously restricted bew rdous waste subject to the Land Disposal Y YARDS <br /> Reatricdons I oeRNy and wanaM that the waste has been treated in a000rdanoe with the requvements of 40 CFR Pan 28a and is no longer a Nf -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 281 at 'the i t qu-b 6 of Exxon JIwI v+» " S Ys CUB[C YARDS <br /> O OTHER <br /> Generator Authorized Agent Nam "7Vt' 7�� �.�t r!��AN f c, /-71L r Shipment Data <br /> TI c><lrnplate a'9 <br /> lection U7TRANSPORTERORTER Ganaratoroompl�sa-d� Transporter n ren <br /> TRANSPORTERI TRANSPORTERII <br /> Dillard T1urking lilt <br /> Name h Name <br /> P 0 GV\ 218 <br /> Address I Address <br /> Byron CA 34511 <br /> Driver Namir Title ! - I Driver Name/Tittle <br /> 15101 B33-6850 PRINTfrYPE PRINTnYPE <br /> phgj"o a Truck No k Phone No I Truck No <br /> I&4cense NOJStatB m Vehicle License NoJState <br /> MZof Receipt of Materials Acknowledgement of Receipt of Materials <br /> w <br /> --- n <br /> Omar Shi Dote DMer Mem. Sn ern Oen <br />"section IIT DESTINATION (Genwtor campfateaa-d,destinadw amt comalistes e4) <br /> BFI Vass@ Rd Landfill 1510) 47-04UI <br /> i Site Name c Phone No <br /> 3001 17otth Vast o Road 1001 'Wl th 11.4 t Ito ill <br /> i Physical Address d Mailing Address <br /> Llteaso" iA 91;`41 L1ECtI101 � c 11 irY <br /> 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 /> JOBP _00., 6a <br /> pos (114-23101 <br /> Norrie of 4uawa:44 agKa S"ture Recolpt Orta <br /> Section IV t th," ASBESTOS (Genemtormml>lowsd f g,operetareaomplstsse . <br /> s Operators Name b Operators Phone No <br /> Operator's Address <br /> i Special Handling Instructions and additional information <br /> OPERATORS CERTIFICATION I hereby tledere that the contents of this consignment are fully and accurately descnbed above by proper shipping name and are classified <br /> Sacked marked and labeled and are in all respects In proper condition for tmnsppn by highway according to applicable International and government regullaatiiorr�nn-s--�tt----rt----rr��'T'�`� <br /> a Operators Name&Title <br /> ppera[a!t Spnarure Oeie <br /> f Name and rgoress�' <br /> of Responsible Agency <br /> g ❑ Friable ❑ Non friable ❑ Both %friable %nonfnable <br /> Adorator refers to the company which owns leases operates wntrols or supervises the facility being demolished or renovated or the demob ion lir renovation operation or both <br /> R ONLY THROUGH BR I UARCO CONTRACT T13ANSPORTER RETAIN ® 260-7200 SN13 <br />