Laserfiche WebLink
S SPECIAL WASTE BESTOS MANIFEST <br /> 11waste is asbestos waste completeN Sectlans t 11 1I1 and IV O� 907638 <br /> g <br /> If wast&IS(1Qj asbestos waste complete only Sections 1 11 and ill !`s <br /> o6UWr (iERATOR (G---,>--aff ar n <br /> Generator Name Cxxon Coupany U S A b Generating Location L` Ulf 31 it.Lull s - 7t), <br /> g$ It$tl[7,i aibrlk+ <br /> Adn,1a a e <br /> OMSS d Address <br /> Houston TX 7:252-2184 olk C <br /> Phone No 1-1131 ;;G-7761 f Phone No ` <br /> owner of the generating facility differs from the generator provide <br /> Owners Name EYSpn CompRm V S A h Owner's Phone No <br /> 48FI WASTE CODEA 4 fl a 0 1 0 f3 7 fi 7 ! .+ Containers DM-METAL DRUM <br /> DP PLASTIC DRUM <br /> 171 `tit, Hazzttdow, Soil B SAG <br /> Description of Waste k Quanti!% ns No TYPE BA B MIL PLASTIC SAG <br /> 4 or WRAP <br /> U (3 iT TRUCK <br /> m O OTHER <br /> GENERATORS CERTIFICATION I hereby certify that the above named mate ii not a hazardous waste as donned by 40 CFR Part 261 or UNITS <br /> any applicable state law has been properly described.classified and packaged "is to proper condition for transportation according to P POUNDS <br /> applicable regulations AND It the wastes a treatment residue of a previously restricted hazardous waste subiect to the Land Disposal Y YARDS <br />{ Resalct ons 1 comfy and warrant that the waste has been treated in accordance with the requirements of 40 CFR Pan 268 and+s no longer a M' CUBIC METERS <br /> hazardous waste asdetrr+edby40CFR PRA 261 dt the te+ uvtiT ut It ,olr Y' CUBIC YARDS <br /> O OTHER <br /> - <br /> Generator AuthbAzed Agent N. a `.N Shipment Date <br /> Transporter 1 mmpleas e g <br /> iectlon TRANSPORTER Generaforbomoleread r rterR Itn <br /> t TRANSPORTERI TRANSPORTERII <br /> ['illutd Ttuckltig III,Name h Name <br /> P 0 anti 218 <br /> Address i Address <br /> 11y,un CA Sb414 <br /> NameMde l �� +p Driver Nameff Itle <br /> c s 1 a 1 13 4-b8;C? PRINTiTPE 4- r k Phone No PRIr4TnYPE <br /> Phope No a Truck No �_ I Truck No <br /> V 3h-'s <br /> lace tate / h/ m Vehicle License NaJState <br /> Acknoryledg ant of R%alpt Of Matenals Acknowledgement of Receipt of Materials <br /> A A n <br /> snw.e t Dace Drtwv signature s tom Date <br /> '7- pwrINAnou (Ge sinsto,m>tpleteca-d.dardnatlm alto compfates e-t) <br /> E1F1 Vasrof Rd Landfill 1101 Ili-+�lUl <br /> L Site Name a Phone No <br /> 4001 -,or th % tet U kuatt 40(31 \QT til Va y+ u hi,Itt <br /> k Physical Address d Madmg Address <br /> Llaetmote CA 91510 Llt+ tu,vie CX }i1 +� <br /> I 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 /> Y <br /> POs 4-30434 <br /> Name at Auuta zad Agent Signatu a Receipt Date <br /> gkt on IV ASBESTOS (Generator complete ad f 9 Operator'cOmPletes a) <br /> 3 Operator's Name b Operator's Phone No <br /> Operators Address <br /> d Special Handling Instructions and additional information <br /> OPERATOR'S CERTIFICATION I hereby declare 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 accordtng to applicable international and government regulations <br /> e Operators Name 8 Title <br /> P-VType Operators Signature Date <br /> f Name and Address ' <br />*5pons,ble Agency <br /> Frible ❑ Nan friable ❑ Both %friable o nonfnab4e <br /> Operator refers lathe company which owns leases operates controls or supervises the facility being demolished or renovated x the demoldion corenovation operation or both <br /> REORDER ONLY THROUGH BFI I UARCO CONTRACT TRANSPORTER RETAIN _ ® 2eaazbe s�3 <br />