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k SPECIAL WASTE RESTOS MANIFEST waste Is asbestos waste Complete Sections L II SII and fV w 1 O. 907632•7�O 7 �7 L��!�S It waste is h QI asbestos waste complete only Sections I Il and 1H ��/ f !d (Generator Completes all d Section 1) 1 L Generator Name * e=011 Cols10mmi, 3 b Generating Location ig � DatlUri Ado . _-ill , ,�r,rr. ^ltib I ,i Address d Address y lJouston n CT ji I toll I I R I Phone No I T 13) 656-77,61 f Phone No 1 I owner of the generating facility differs from the generator provide E=oa Cow ast� L S .I y Owner's Name t+ h Owner's Phone No Snafti s I(� 1 TYPE WASTE LADE Y l 0 J L 8 J B i 4 3 i Containers OM-METAL DRUM DP PLASTIC DRUM Non RaxaLdous Solt B BAG Descnpdon of Waste k Quaint Unna No TYPE BA 6 MILor WRAC BAG g 17 1 F1_1 T TRUCK O OTHER GENERATOR CERTIFICATION 1 hereby certify that the above named malarial is not a hazardous waste as defined by 40 CFR Part 261 or UNITS any applicable state law has been properly described elaiasdled and paekayed and is In proper condition kw transportation according 10P POUNDS applicable regulations AND.If the waste is a treatment residue of a previously restricted hazardous wash subject to the Land Disposal Y -YARDS Resafctlans.I certify and warrent that the waste has been treated In accordance with the requirements of 40 CFR Part 268 and Is no longer a M' -CUBIC METERS hazardous waste asdetlnedby40CFR Part 261 eLt the 1&tlUtat of Eason ComY' CUBIC YARDS O OTHER Generator Authorized Agent Shipment Date Seclon II=I= -> TRANSPORTER Generator complete a-d. T rwr IIOOr��°tart TRANSPORTER[ +TRANSPORTERII Dillard Truckil,e: 1 t Name it h Name P 0 Du t 216 � Address I Address $SI on CA 0,151 I Driver Nam ale lAlf r I Driver NarnelTide (-to) 621-f)(1150 PRINTITYPE PRINTrrYPE` j Phone No a Truck No i r k Phone No I Truck*40 f Vehicle License NoJState .3 -)I r r m Vehicle License NoJState Acknowledgement of Receipt of Matenhls Acknowledgement of Receipt of Matenals g 1 .1. n 777 DINV y yim sh pate D"r err. Stile=i Oma $e Otp,gT «yds DESTINATION (Generator completes a-4 dhlNwtionaft c—Platee04) a Site Name BFT 11dbro Rd Linrltlll c Phone No -til 14"-f l9l 3001 N01 T 1 ', 1 f , F c.�a, 4001 \„t til �a�t rl 'Ulld b Physical Address d Matting Address L31,atall t CA 9l ;"O Li vetslute C',l ria :J e Discrepancy Indication Space I hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing Is true and accurate f POs 43-20101 Name of Aea,onzed A9anr 54gneWra pm;w Data Section IV 1* ASBESTOS (Genarator comprota as f g Operator ComPlehs a) S a Operator's Name b Operator's'Phone No c Operator's'Address d Special Handling Instructions and additional Information OPERATOR'S CERTIFICATION I hereby declare that the contents of this consignment are luily,and accurately described above by propgr shipping name and are ciasslrued i packed marked and labeled and are in all respects In proper condition for transport by higrway according to applicable international and government regulations F e Operators Name Title -T oL_L-L�J Prvrcrrype Operemrs Signatwe ate 0f oma and Address esponslble Agency g Friable ❑ Non friable ❑ Both %friab4e %nonfrlable Operator refers to aha Company which Owns leases Operates controls or supervises the facility being tlemol3hed or renovated or the demolition M renovation operation or both RFORDER ONLY THROUGH BFI I UARCO CONTRACT9 zfio-noa siva TRANSPORTER RETAIN