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ON•RMAIZARD..,US SPECIAL WASTE & ...;BESTOS MANIFEST <br /> if waste Is asbestos waste complete Sections t Il 111 and IV No. 907946 <br /> !f waste is UQL asbestos waste complete only Sections 1 11 and III <br /> I GENERATOR (Gsnera or completes as of section 0 <br /> a Generator Name b Generating Location <br /> 1 <br /> c Address + d Address <br /> a Phone No -+ - f Phone No <br /> If owner of the generating facility drifers from the generator provide <br /> g Owners Name r h Owner's Phone No <br /> TYpE <br /> L DRUM <br /> I BF1 WASTE CODE m 1 Con[ainars DP LA TIC DRUM <br /> B BAG <br /> I Description of Waste s — _it QuantitV unre No TYPE BA 6 MIL PLASTIC BAG <br /> or 0 ED El O OTHER WRAP <br /> GENERATOR S CERTIFICATION f hereby certify that the above named material is not a hazardous waste as debited by 40 CFR Part 281 or UNI7s� <br /> any applicable state law has been property deacnbed classified and packaged and Is In proper condition fof transportation according to P POUNDS <br /> applicable regulations AND if the waste Is s treatment residue at a previously restricted hazardous waste subject to the tend Disposal Y YARDS <br /> Restrictions I carbfy and warrant that the waste has been treated In accordance with the requirements of 40 CFR Pan 288 aro Is no conger a M' CUBIC METERS <br /> hazardous waste as de�Ta�ed qpyy 40LCpR Part 281 Y' CUBIC YARDS <br /> li�Na:n F.JT..xetrl t r r } t- O OTHER <br /> Generator Aufhonze4Agent NameSigna re �,�In`:F", Shipment Daps <br /> Section 11 TRANSPORTER Generworcompletea-d T�'BpOrre R �rn <br /> TRANSPORTERI TRANSPORTER(f <br /> a Name DI. i 'r ; " i r It Name <br /> b Address f I Address <br /> c 0n3w NameMtle b Omrer Name/Title <br /> PRINYMPE q PRINT/T'PE <br /> it Phone No Truck No <br /> 4e Truck No <br /> 'f chicle License NolState J� ? __ _— m Vehicle License No-/State <br /> Acknowledgement of Receipt of Materials Acknowledgement of Receipt of Materials <br /> n <br /> Drlver'S huB Sh1 t Date Drtvx re Sh m*nl Dots <br /> S n III DESTINATION destkralian alta completes e.f) <br /> a. Site Name Bt+T .YtCr' t Fur 1 hurl i t c Phone No -1 1 I -cr t - <br /> b Physical Address 1 1,11 y<.+ t , d MailingAddress 9 " <br /> E €VI +at,1 i €I i'- <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 /> •�f? 9 <br /> — r <br /> / <br /> i None at AUVwnr*e Wens s4nature Rece+pt 080 <br /> Section IV `4 - ASBESTOS (Generator complete as f g Operator camPww e) <br /> a Operator's Name b Operators Phone No <br /> c Operator's Address <br /> d Special Handling Instructions and additional information <br /> OPERATORS 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 international and government regulations <br /> a Operator's Name&Tgle PnmlOat* <br /> ryp* Ope+ator's Sgnawre <br /> I Name and Address <br /> of Responsible Agency <br /> g ❑ Friable ❑ Non friable ❑ Both °6 friable %nonfrlable <br /> 0peralor raters td the company wnlch owns leases operates controls or supervises the faclhty being demolisnad or renovated or the demolNon or ranovatlon operation or both <br /> REORDER ONLY THROUGH BFI 1 UARCO f:OWrRACr " Q Zed-7209 5 93 <br /> TRANSPORTER RETAIN <br />