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NON-HAZARbarUS SPECIAL WASTE &)wSBESTOS MANIFEST <br /> tf waste is asbestos waste complete Sections 1 II Ill and IV No. 907956, <br /> If waste is NQJ asbestos waste Complete only Sections t ll and 111 <br /> 3 <br /> 177- <br /> " - GENERATOR (Generator oompletee till of sectlan n <br /> Generator Name b Generating Location <br /> Address �'f ' r d Address <br /> x, T <br /> Phone No l ` I Phone No <br /> owner of the generating facility differs from the generator provide <br /> Owner's Name f 'All 'I h Owner's Phone No <br /> UP-E <br /> BFI WASTE CODE Containers DM METAL DRUM <br /> DP PLASTIC DRUM <br /> B SAG <br /> Description of Waste �°' " N t i` ' I k Quantity Wats No TYPE BA 6 MIL PLASTIC BAG <br /> m m WRAP <br /> T TRUCK <br /> O OTHER <br /> GENERATOR S CERTIFICATION I hereby coney that the above named matenei a not a hazardous waste as defined try 40 GFR Part 261 or U W5 <br /> any applicable state law has Dean properly described classified and packaged and is in proper oondrtlon for transportation according to P POUNDS <br /> applicable regulations AND If the waste is a treatment residue of a previously restricted hazardous waste subject to the land Disposal Y YARDS <br /> Restrictions I certify and warrant that the waste has been treated in accordance with the requirements of 40 CFR Part 26B and is no longer a M' CUBIC METERS <br /> hazardous waste as Refined by 40 CFR Part 261 1 t l k 'I i 1 Yr CUBIC YARDS <br /> r o OTHER <br /> V <br /> Generator Authorized A*nt Name Svabue !F J n� ` Shipment Date <br /> Section II TRANSPORTER r�erter.tDrr>omptataa-d. TT rterariaporterIs e'n,tg <br /> TRANSPORTERI TRANSPORTERII <br /> DLII Fie Ir , t i„ I <br /> a Name h Name <br /> Ir hvL t + <br /> a Address 1 Address <br /> Driver NameirTitle a y Qn'ver Namemtfe <br /> _1 PpINT/ttPE PRINTITYPE <br /> J Phone No { f 1 t i e Truck No 02;/3Q71 k Phone No I Truck No <br /> Ito License NoJState f 1 S/n 1-r! m Vehicle Ucense NOJStajle <br /> nowlledgement of Receipt of Materia s Acknowledgement of Receipt Of Materials <br /> DMx wro <br /> shlpmem Date Omer SI avers Shi aril Dare <br /> Section III DESTINATION (Generator oompietes a-d desttriation eke completes e4) <br /> 4 1 , 3713 i 1 1 r f 1 1 1 <br /> a Site Name c Phone No <br /> E, 1 Nut t ri } i n ] t ,rl <br /> b Physical Address d Marling Address <br /> t.l r moi f <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 /> TO 1rsE1� 'Isr+. {,c, <br /> f f tip <br /> Name of Authorized�2.ft Si UM" AeceiW Dav <br /> Sectlan IV ASBESTOS (Generator complete as f g Operator-completes a) <br /> a Operator's Name b Operator's Phone No <br /> c Operator's Address <br /> i <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 regulllatitio�-n-s-��-I�I'--ISI <br /> e Operator's Name&Title <br /> Pnntrrype Opwiiws Sgnature Dpte <br /> f Name and Address ' <br /> of Responsible Agency <br /> g ❑ Fnable ❑ Non Inable ❑ Both %friable %nonfrtable <br /> rotor refers to the company which owns leases operates Controls or supervises the facidy being demolished or renovated or the demolition or renovation operation or both <br /> ER ONLY THROUGH BFI 1 UARCO CONTRACT TRANSPORTER RETAIN © 260-72M SA13 <br />