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QS SPECIAL WASTE &--SBESTOS MANIFEST <br /> IfL"waste Is asbestos waste complete Sert1Ons 1 II 111 and IN No 9 7 9 1 ly <br /> I waste is QTT asbestos waste complete only Sections s is and I II N J V _1 <br /> S ,o-n 1 ` GENERATOR (Generator compiates atl of Sookin q <br /> a ator Name ^' b Generating Location <br /> i' I tit ,�c ,1. <br /> Address r d Address <br /> e Phone No - ( I Phone NQ <br /> If owner of the generating facility differs from the generator provide <br /> g Owner's Name f t11 ' + h Owner s Phone No P <br /> TYPE <br /> BFI WASTE CODE m Contamers DM METAL DRUM <br /> DP PLASTIC DRUM <br /> B BAG <br /> Description of Waste ui +i s s, k Quantityunits No TYPE BA 6 MIL PLASTIC BAG <br /> or <br /> r fi [I m []] <br /> T TRUCK <br /> O OTHER WRAP <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous waste as defined by 40 CFP Part 261 or UNITS <br /> any applicable state law nes bean property descnbed classified and packaged and Is In proper condition for transportation according to P POUNDS <br /> applicable regulations A#AW the waate Is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Y YARDS <br /> Restridlons I certify and•tir,)*ni Mai the waste has been treated in accordance mth the requirements of 40 CFR Part 268 and is no longer a M' CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261 it rile !.l+ + r i P 114 11 1. Ys CUBIC YARDS <br /> v OTHER <br /> Generator Authorized Agent Name SIg(2tu�a _ $hipment Data <br /> r nr <br /> Section II TRANSPORTER Generator co plate a-d i=nai n�sBese�tt$r1 <br /> TRANSPORTER] TRANSPORTER]] <br /> it rr f <br /> it, I' lila: 111 <br /> a Name h Name <br /> b Address I Address <br /> c Driver Namer title Tr i i _ I Driver Name/Title <br /> { 1 + I PRINTT'PE PRINT17YPE <br /> d Phone tJD a Trude Nb ,s/c k Phone No I Truck No <br /> f Vehicle License No/State ✓-Y /:• �r��J yl r m Vehicle License No 1State <br /> owledgement of Receipt of Materials Acknowledgement of Receipt of Materials <br /> r <br /> " G n <br /> orrver a re Shy mem Date I Enver S nature Srn mans Dai. <br /> Sectron III DESTINATION (Generator completes a-d destination ails complates e-f) <br /> a Site Name c Phone No <br /> b Physical Address d Mailing Address <br /> e Oiscrepancy Indication Space <br /> t hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> f <br /> Named Ausnonzed Agent Sgruture Reuipl Dare <br /> Section N ASBESTOS (Generator complete a-d 1 g Operator'compfetea e f <br /> a Operator's Name b Operators Phone No <br /> c Operators Address <br /> d Special Handling Instructions and additional information <br /> OPERATOR'S CERTFFICATION 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 m proper condition for transport by highway according to applicable international and government regulations <br /> e Operators Name&Title l <br /> Pnnt/Type Operator 5 5 gnature Date <br /> ' Name and Address <br /> of Responsible Agency <br /> 9 ] Enable F Non fnanle [:1 Both %friable %nonfnable <br /> Operator refers to the company wn4n owns eases operates rpnrrots or supervises the tacJily being demohshed cr renovated Or the demolition or renovation operation or both <br /> INERONLY THROUGH BFI,UARCOCONTRACT gANSPORTEP RETAIN 9 2607209Sr93 <br />