Laserfiche WebLink
e complete only Sections 1 It and III NO 907639 <br /> GENERATOR Teen tratw mmplates da of sicnon 11 <br /> Sor Name��;,�( L`Non Cnpluait� U 5 1 b Generating Location E ti.!ir ,C t t l ui, = <br /> JW <br /> YU7�1121I5 d*641- Cifu��lnatl�i, ,uluii, d Address 17�r7 uiintt, it11� R td <br /> IE,�lz�tu . TS 7785j ;11�, aslrtui, f <br /> (71II 3;r,-;751 I Phone No t <br />� Phone No <br /> 1 owner of tha generating facility differs from the generator provide <br /> 1 Owner's Name E sl?ti Compam t ~ h Owners Phone No Same t, <br /> TYPE <br /> BFI WASTE CODE ; D - ' l y f. E 7 3 7 Containers OM METAL DRUM <br /> DP-PLASTIC DRUM <br /> B BAG <br /> Description of Waste 4url Hlt'.al,1,,,, , i l k luand Vnits No TYPE BA $MIL PLASTIC BAG <br /> or 0 0 3111E 0 1 4 T T TRUCK <br /> OTHER WRAP <br /> GENERATORS CEFITIFICATION I hereby cerety that the above named matonai is not a hazardous waste as defined by 40 CFR Part 281 or UNITS <br /> any applicable state taw has bean properly described classified and packaged and 18 Ln proper condition for transportabon according to P POUNDS <br /> applicable regulations AND if the waste is a treatment residue of a previously restricted hazardous waste sublet[to the Land Disposal Y YARDS <br /> Restnidoons I Car*and warrant that the waste has been treated in accordance with the requirements of 40 CFR Part M and is no longer a M' CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 281 at 111, i�tr1t� t .)I r-,,, r,li ° i gar r Y' CUBIC YARDS <br /> .i <br /> O OTHER <br /> TL .r i ! f/ / f 22 <br /> Generator Authorized Agent blemet A19nathins Shipment Date <br /> Lr <br /> Section R NSPORTER Gendratdreompleta ae T rfl teom tai ii <br /> TRANSPORTERI TRANSPORTERII <br /> a Name D1IIdtf1 Ti-it.kktri: ilii h Name <br /> b Address P C Bol 21'1 <br /> Address <br /> Bt I loll CA -31511 <br /> c Driver Name/ritle 'P�,u IC�� _ 1 DriverNamefrUe <br /> t.�,10 1 63!-„,3 5I1 PRINTrrYP£ PRIRiT/i'1'PE <br /> d Phone No a Truck No � k Phone No l Truck No <br /> f Vehicle License NoJState _ `'1,8 2a-Z A4- _ m Vehicle License NoJState <br />" <br /> gowledgement of Receipt of Matenals Acknowledgement of Receipt of Materials <br /> '/ I n/ !} �, <br /> D ,r Shomr onto Drover S. tors sl t Date <br /> Section DESTINATION (Generatormiriplalesa-d dastinatlosftcompmtow84) <br /> a Site Nemo c Phone No <br /> BFI Vasru Rd tandrtli 11101 117-0191 <br /> 3001 `lit T It ,o, 1, ul 401"!1 North %t�4 o ftv,,,1 <br /> b Physical Address d Mailing Address <br /> Ll i'et,%„lW a 'tfi� 1`,I`t rart.tC L A iI-SO <br /> r <br /> e 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 /> 1[713= 3002 rz <br /> f ���� f P^: 0�_204,j 20,x 9 1 <br /> Nam.a A,ahoaaed MK„ Sip ea a Recegt Dare <br /> SecfionIV �a- ASBESTOS (Ganererorcciripfelead g operatormmpietdeel <br /> a Operator's`Name b Operators Phone No <br /> c Operator's 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 according to applicable intemational and government regulations II-T-TT1I <br /> e Operator's-Name&Title "- <br /> are,veyP. operators Spnature Date <br /> f Name and Address <br /> of Responsible Agency <br /> g ❑ Friable ❑ Non fnable ❑ Both %friable %nonfnable <br /> Operator refers 10 the company which owns leas” operates controls or supervises the facility being demolished or renovated or the demontion or renovation operation or both <br /> DER ONLY THROUGH 9Ft l UARCO CONTRACT TRANSPORTER RETAIN ® z80'7p0 5,93 <br />