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NON•HAZARD,.(tUS SPECIAL WASTE &'WSBESTOS MANIFEST <br /> if waste Is asbestos waste complete Sections 1 It III and IV No. 90-1960 <br /> if waste is=asbestos waste complete only Sections 1 11 and III <br /> P 9*t-tW -r; GENERATOR (Genet"com meal as of Section 1) <br /> 3 Wrator Name 1... titin Cil Rirlt►Y i+ > b Generating Location H t +r z - <br /> ct`J e <br /> Address k�trGIA tIr #_� }rirt d Address Oil, tt <br /> liouatost T% 77—Se--'_lc -t r, 4ton <br /> a Phone No (71 + o.8—i'6l f Phone No ti ► <br /> If owner of the generatir gi facility differs from the generator provide <br /> g Owner's Name Exxon Corapdnt o 7 ,, h Owners Phone No tpiry It <br /> I BFI WASTE CODE M,% FTc)[I J I _ 1 1 Containers DM METAL DM <br /> DP PLASTIC DRUM <br /> 8 BAG <br /> 1 Description of Waste Non Hal rryll,m, hr it k Quantity <br /> ll lima No TYPE BA 6 MIL PLASTIC BAG <br /> or f T TRUCK <br /> OTHER <br /> WRAP <br /> E10 - <br /> GENERATORS CERTIFICATION: I hereby cera ly that the above named material is riot a tazardous waste as defined by 40 CFR Pan 281 or UNITS <br /> arty awkable state taw has been properly described,classified and packaged and is in proper condition tar transportation according to P POUNDS <br /> appkable reigulaa«as AND.If the waste Is a b.sunsnt residue of a previously restricted hazardous waste sublect to the Land Disposal Y -YARDS <br /> Restrictions I comfy and warrant that the waste has been treated fn accordance with the reltuarements of 40 CFR Pan 268 and is no longer a M' CUBIC METERS <br /> hazardous was`as defined by 40 CFR Part 261 $t t f r; ,i,f� I F, t+ + p CUBIC YARDS <br /> h O OTHER <br /> U _ _ Gf ' �J <br /> Generator Authorized Agw#Name SiggatureS Shipment Date <br /> I�,ilii n.rib f <br /> HsPoRTF-R Generator efa Tfenap°n Wit'n�.a <br /> TRANSPORTERI TRANSPORTERSI <br /> a. Name W I l at it Trucking Inc h Name <br /> I <br /> b Address Address <br /> c Oriver NameMtle I Onver Name/Title <br /> PRINTrrYPE PRINTMPO <br /> d Phone No S rr7`� i*t�'r"e Trach No k Phone No I Truck No <br /> 1 fe license NodState 0*1 /�`�i� m Vehide License NodState - - <br /> owledgernent of Reoei bpi gWga*)V6. y, �r7 Acknowledgement of Receipt of Materials , <br /> .11 1g n <br /> Drfwr etilfe .. Shl roam Gala Orvar a anus Shi r Oole <br /> Sect& DESTIN 0 (osneratur completes a-d destlrratlon site cnripietes e E} <br /> of tirr+e i R +rrli t I i >1t01 If <br /> a Site Name C Phone No -- <br /> b Physical Address N +r 4 d Mailing Address hr = I r <br /> (. L , t=r , fIJut I.tt -?1 <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 <br /> NaFt—M Oat* <br /> Nellie d Autl+odzed Again 5ynatura <br /> Section IV ASBESTOS (Generamr compete as I g,operator completas e.) <br /> a Operator's Name b Operators`Phone No <br /> c Operator's Address <br /> d Special Dandling 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 cdassdted <br /> packed marked and labeied and are in all respects in proper condition for transport by highway according to applicable international and government regulations <br /> a Operator's Name&Title <br /> Pnnveype operators s"a+r. Dais <br /> f Name and Address <br /> of Responsible Agency <br /> g ❑ Friable ❑ Non friable ❑ Both %inable %nonfnabie <br /> Operator revers to the company which owns leases operates controls or supervises the facility being demolisred or renovated or the demolition or renovation operation or both <br /> R ONLY THROUGH BFI f UARCO CONTRACT TRANSPORTER RETAIN - ® Z54>'zoa s53 <br />