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NON,HAZARQJS SPECIAL WASTE & kSOESTOS MANIFEST <br /> If waste Is asbestos waste complete Sections 1 11 al and IV No. 907958 <br /> II waste la t Q1 asbestos waste complete only Sections I It and In 1�1 <br /> Section i- *7 GENERATOR (Gaaerator 170frIpfBlOa all Sectlan t1 <br /> a Generator Name i �♦,nat ''utanntl L S ,y b Generating Location <br /> n <br /> C Address i h -` d Address es 11 I i, w 1 <br /> H,u,L tit i tc kT it <br /> e Phone No 1'1 , .15t, f Phone No <br /> It owner of the generating facility(10arts from the generator provide <br /> g Owner's Name u t III t n, <br /> h Owners Phone No <br /> TYPE <br /> I BFI WASTE CODE I y I I I I Containers DM METAL OPIUM <br /> DP PLASTIC DRUM <br /> ",rtri r!.r it di-i -,t I I B -BAG <br /> j DesCnphon of Waste k Quant! Brits No TYPE BA -6 MIL PLASTIC BAG <br /> T CK <br /> O TRU or <br /> OTHER WRAP <br /> GENERATOR S CERTIFICATION I hereby cerhty that the above named material,s not a hazardous waste as defined by 40 CFR Pan 287 or UNITS <br /> arty applicable state law has been property described classened ant packaged and<s in proper rxndaron for transportation according to P POUNDS <br /> applicable regulations AND If the waste Is a trartment residue of a pravioualy restricted hazardous waste subject to the Land Disposal Y YARDS <br /> RaetniCtlons I comfy and warrant that the waste has been treated In accordance with the requirements of 40 CFR Part 268 anti Is no longer a M' CUBIC METERS <br /> hatardous waste as defined by 40 CFR Pan 261 1, Aja t �u , r tr n: 1 y Y' CUBIC YARDS <br /> y }r e <br /> tl�iwfir Hyl!t� `j r ��i` ' O OTHER <br /> Generator Authorized Ag Name S 9nature Shipment Rate <br /> TRANSPORTER liereaporcorigilma Tlit Mn <br /> TRANSPORTERI TRANSPORTERII <br /> i'11I-tId Txurbt1L I,it <br /> a. Name h Name <br /> P ^ [St) .,La <br /> b Address I Address <br /> HI m it"! <br /> Ona <br /> OnverNams/ itle <br /> tPRINTRvPE <br /> No a Truck No fl r k Phone No I Truck No <br /> f Vehicle License NoJState "6 �7_ m Vehicle License NoJState <br /> Acknowledgement of R pt of M tenals � Acknowledgement of Receipt of Matenais <br /> 9 14Z 42 n <br /> U,Nw to Sh t Dele Diner S lure Sh, nt Date <br /> Section ift DESTINATION (Generawr completes" destination site oompistes e.f) <br /> i;f t r,r� I I,.� [ tri 3i c , I <br /> a. Site Name c Phone No <br /> b Physical Address d Mailing Address <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 /> Name m twun,4ad aerie SlOnatlrs Ric vt pgt4 _" <br /> Section IV ASBESTOS (Generator templetsa-d f p Operator'completese <br /> a Operator's'Name b Operator's Phone No <br /> c Operator's Address <br /> d Special Handling Instructions and additional Information <br /> OPERATORS CERTIFICATION i hereby declare that the contents cit this consignment are fully and accurately described above by proper shipping name and are ciassilieo <br /> packed marked and labeled and are In all respects In proper condition for transport by highway according to appllcabie international and govemment regulations <br /> a Operator's Name&Title <br /> PnnUrype operam s saynaw- Date <br /> f Name and Address <br /> 6FnableoofRespoAgency <br /> 7_1 Non friable ❑ Both %friable %nonfrlable <br /> orator reler$to the company which owns leases operates Controls or sLiperviSee the facility being demolished or renovated or the demolition or renovation ooerawn or bolh <br /> REORDER ONLY THROUGH BFI/UARGO CONTRACT TRANSPORTER RETAIN Q 260 720a 3'83 <br />