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r � <br /> AL WASTE &I.JBESTOS MANIFEST <br /> It waste Is asbestos waste complete Sections 1 11 f1f and IV No. 907903 b Q r3 <br /> if waste Is C14I asbestos waste complete only Sections[ [[and Ill 1�1 J �7 J <br /> Section I GENERATOR (Generator completes an of sectio,o <br /> ratorName E%'(011 Cua(1ala L S A b Generating Location 1- + it Ili ar, = 708 <br /> �n21PSa,,h j4A; tgt;t tot Witiltr <br /> c rasa t d Address <br /> H0W'ti_)u TS 7735 ^-}B(, 5to, )(tui, £ <br /> a Phone No t 13) r,56-77j)( f Phone No J R <br />_11 owner of the generating facility differs from the generator provide <br /> g Owner's Name EtKutu CowpAwi, L A� h Owner's Phone No <br /> TYPE <br /> I BFI WASTE CODE • 0 0 s s ,i n 1 Containers OM METAL DRUM <br /> OP PLASTIC DRUM <br /> rvu fid di. ] Itt .0 t l 8 BAG <br /> 1 Description of Waste k Ouantrt Unds No TYPE BA 6 MIL PLASTIC.�AG <br /> or WRAP <br /> C U 0 ! 7 I T T TRUCK <br /> O -OTHER + 01 <br /> GENERATORS CERTIFICATION I hereby certify that the shove named material is not a hazallous waste as defined by 40 CFR Pan 261 or UNITS <br /> AnY aPPlt¢able state law has been Property described clasaled and packaged and is in proper condition for transportation according to P POUNDS <br /> applkable regulations AND it the waste It a treatment residuevgf a Previously reatrlelW hazardous wasla subject to the Land 4rsposal Y YARDS <br /> -AINUICUOns I Clingy and waneM that the waste has been treated in accordance with the requirements of 40 CFR Part 266 and,s no longer a M' -CUBIC METERS <br /> --Aaxatdous waste as defined by 40 CFR Part 261 r i. t i1P 1 t q u� t y;P C n It !`Uta I S Y' CUBIC YARDS <br /> y O OTHER <br /> Generator Authorized Agent Nam a¢, Shipment Dam <br /> SectionII TRANSPOR R GeneratorrbrnpWoa.& TZ=nCOr"�a1s hamn <br /> TRANSPORTER I TRANSPORTER H <br /> D111drd Tiucklug Itic <br /> a-Name h Name <br /> b Address P FlU� 41f3 <br /> i Address <br /> - lit t uu C.3 5351 1 r <br /> G-onvelttame(Title / ( Driver Namn l & <br /> r.)t 62'0^j; ).7 PRINTrrYP PRiNYRY <br /> d Phone No a 7 ck No /�/_ k Phone No 1 Truck No <br /> I Vehicle Incense NoJState 1 <br /> Vehicle License No!State <br /> mowledgemen of eceip rZalIa Acknowledgement of Receipt of Materials <br /> g FT I 1 17n <br /> nn�er i Oeie prtver S asura Sh rnent Date <br /> SAC110n III DESTiNxp (Generator completes a-d,tlasanation site oompletea&.f) <br /> BFt ��1suo Rd Landfill 1310) 1f7-octal <br /> a Site Name c Phone No <br /> b Physical Address <br /> 1001 Korth Vdord Matting Address <br /> u Road 4(,J] %orth ',abco Rcad <br /> Lltefenote Ct, R1556 Li< t,,imore CA ,111,50 <br /> a Discrepancy Indication Space ,,tte�rr <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 /> i� <br /> JOBS 3000 BF <br /> Name dnVudnenarf AgraPOO 05-201r3) <br /> r� Sfgiiaare Receipt Dale <br /> StBc ion IV 'j.4 k A.SSE (Generatormmpiaw"f S Oparaw fwnpleres a.) <br /> 3 Operator's'Name b Qperatos s Phone No Aft <br /> Qperawra'Address I <br /> I Special Handling Instructions and additional information IL <br /> OPERATORS CEFIT15CATION I hereby declare that the contents of this consignment are iuily and accurately dascnb@d above by proper shipping name and are classified <br /> cracked marked and labeled and are in all respects in proper condition for transport by highway according to applicable international and government regulations <br /> f Oparawrs'Name&Tide <br /> Primveype Operators signature Dare <br /> Name and Address <br /> of Responsible Agency <br /> I ❑ Friable ❑ Non friable ❑ Both %friable %nordnable <br /> Operator refers to the company which owns leases operates controls or Supervises the fac0ty being demolished or renovated or the demolition or renovation operation or both <br /> 3ED ER ONLY THROUGH BFI r UARCO CONTRACT TRANSPORTER RETAIN 2607208593 <br />