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L. <br /> 1 �1rIS SPECIAL WASTE & ,—IBESTOS MANIFEST <br /> 0 If waste is asbestofWaste cpmpiate Sections t It III and IV No. 907902 <br /> !. rests is NQJ asbestos waste complete only Sections 1 U and III <br /> r VERA OR`fGarivauv wing"ail a!soclfano - <br /> a Generator Name Exxon Carberry Ir S a b Generating Location Lion trcult = <br /> n31$ utul i kl, P 1 <br /> c Address � = u� d Address if <br /> Holliston 'T4 ' 'V,25= 2380 LU, Flvii L <br /> e Phone No !7131 656-7781 I PhortaL.No <br /> If owner of the generating facility differs from the generator provide y' <br /> g Owners Name Exxon CowpflriV L S A h Owner's Phone No Sallie da I I r i <br /> ` t TYPE <br /> I BFI WASTE CODE ! 0 0 ! 0 R f) T F00 3 7 r Containers DM METAL DRUM <br /> DP PLASTIC DRUM <br /> Nan H.tza,duo-b St+t I f3 BAG <br /> j Description of Waste k Quanti thab No TYPE BA 6 Mll PLASTIC SAG <br /> or WRAP <br /> El <br /> O OTHER <br /> f L�JJ <br /> GENERATOR'S CERTIFICATION I heratty certify trier ere above named material Is riot a hazardous waste as defined by 40 CFR Part 261 or UNITS <br /> any appacahle state law has been 0opedy,described Gase+tled and pack god and is in proper condition for transportation according to P POUNDS <br /> applicable regulations AND N the waste Is a treatment residue of a previously restricted hazardous,waste subject to the Lard Disposal Y YARDS <br /> Restrictions,I caniy and warrant that the waste has been treated in a000rdance wdh the regtllrements at 40 CFR Part 268 and is no longer a M' CUBIC METERS <br /> hazardous wastasadeflnedby40CFR Part 261 gt the t equi ut of Exxon f U4 r t' Ya -CUBIC YARDS <br /> %JFL04—T PE+z 1 t 11' r 1 1 O k O OTHER <br /> Gensratdr Auttwn:ad Agent Nam t G A/V /I V!Vi>r -- ; Shipment Gate <br /> 7 <br /> P�r k. a` t TRANSPORTER Generator oariwlete.4 T Ir = <br /> TRANSPORTER I TRANSPORTER ll <br /> Dillard Trucking Int <br /> a Name h,.Name <br /> P 0 Box 218 <br /> b Address i Address <br /> B\roR CA OM4 <br /> DAlier Narttle <br /> f 5101 $ I–ri850 PFuNTNYP1t,- PRlNrm <br /> d Phone No ] e Truck No k Phone Nd I Truck No <br /> f Vehicle License NcJState S f–r.� m Vehicle license No/State I <br /> Acknowledgement of Receipt of Matesats Ackaowledgement of Receipt of Materials <br /> g n T1 <br /> Dr. r gate 1 cf r S amore S Date <br /> 5 A 'r, _, DESTINATION (C,eneraw eompietes as etsetinatfan eits'6omWstea e t) <br /> SIFI 6iAstu Rd Lautltilt + -110) 117-0191 <br /> a Site Name c Phone No <br /> 4001 riot tri #t,d 3001 !Ot tit last u R,irtil <br /> b. Physical Address d Mailing Address <br /> f' Lv.eIIso tt' CA 3!1,SO f Lent-tTOO'e CA {1`1�n <br /> e Discrepancy Indication Space <br /> I hereby certify that the above named material has been accepted and to the treat of my knowledge the foregoing is true and accurate <br /> /� ?11ri� '4t)2 tib <br /> f NameotAUlhavaaApem sgxrura ,;-`� POs 09--30!'91 <br /> Remo Doui <br /> Section IV T ASBESTOS (Generator complete a-d f g Operator completes s) _ 4 <br /> a Operator's Name b OperStors Phone No _ <br /> c Operator's Address <br /> d Special Handling Instructions and additional Information <br /> i <br /> OPERATORS CERTIFICATION I hereby doom that the contents of this consignment are fully and accurately described above by proper shipping name and are classified <br /> packed marked and labeled and are in all respects in proper Condition for transport by highway according to applicable International and government regulations <br /> e Operators`Name&Title <br /> Pm[Rype Operators Signature D. <br /> f Name and Address <br /> of Responsible Agency <br /> soFriable ❑ Non friable ❑ Both %friable %nonfrlabie <br /> Operator raters w the company which awns leaaea operates cohirols or supervises the facility bavng'demolished or renovated Or ne demolition or renovation operation or both <br />' REORDER ONLY THROUGHBFI 1 UARCO CONTRACT ® 2aarzda sm3 <br />` TRANSPORTER RETAIN <br />