Laserfiche WebLink
�. R PQ;BBLOC . HOWKAiZe�ARGQC.,S.SPEi� IAL WAS'T'E&ASIBESTOS IWANIFE r'r <br /> apt j. <br /> ( �• If wastels asbestos waste;cc6iplete Sections I,II,III and IV <br /> J 4 '!f waste is NOT^dsbestos waste,complet9 Seotlons 1.It and III <br /> I. GENES OR (Generator complete la-r) <br /> a.[3snerators UVEPA ID Number b.Manife t odutilent Number c.Page 1 of 2- <br /> TIM <br /> e, <br /> d.Goneratfs N and Location: Generator's Mailing Addre �: <br /> .rtfxevalt;atfhP, stave Met i1%, 8 <br /> 73�fi A;..E.i.E�nrricicl`fit, M Ram Aird"title~' <br /> Skjr,'Irinit,CA. CXW- f �t��l�7�3t� 40ejldot�;�;,f� <br /> f.Phone: �.Phoneme _ <br /> If owner o the generating facility differs from the generator,provide: <br /> h.Owner's Name: i.owner's Phone No,: <br /> j.Weste Profile f1 Ic.Exp.Date I.Waste Shipping Name and m.Con ainors a,To <br /> 6.-Unit <br /> y Description No. Type Qujd/antit Wf11/ol,71� JaSailfl+fdU7t: 1f � �����' <br /> Y_ <br /> GEN) RATUf2'S CERTIFIGATION: t hereby certify that the,above horned rpa 8rial is"t10 a haz�aardous wastA 2s.iby 41)CFR 261 r any,applicabla <br /> state law,has been.properly described,classified and paolcaged,and Is in�rclperfL`ondi'ti n f�o'f b"porlation according to applicable regulations;AND,if this <br /> waste Is a treatment residue of a.previouely restricted hazardous waste SU1516et to the end Dispdsel Restrictions,I certify and warrant that the waste has <br /> { been treated in q9cordancq with the requirements of 40 CFR 26 d i4alonger a r ous este as defined by 40 CFR 261. <br /> Generator Authorized Agent N me..(Pdnt r irrg'• r,Dae f <br /> IL TRANSPORTER Generafio caret'lutes Ilatb:'and.Transporter cum (etas Ile e <br /> a.Tram,go�rt"ers Nie and Address: � <br /> r <br /> b.Phrilier•' ..�.. ••�. f <br /> c.Driver Name(Print f e.Date <br /> i 111: DESTINATION (Genel'at0i' plots Ills-c. d'I7estination: ite"completes Illd-g) - <br /> a.Dis osall,Faclllt, nd Set Address: y c:,US EPA Number d:Discrepancy Indication Space: <br /> � p 1-fWtal�!�zf�71t1� <br /> Muelteca,CA W116 <br /> - <br /> b <br /> I hereb cert) that the above named materibt pe b' c ' esr nowled a the fora oI Is and i <br /> s.Name of Authorized A ani Print) iiatur Date"' m <br /> IV. ASBESTOS (Generatote•IVg-i) <br /> a,Operator's Nome and Address: c,Responsible Agency Name and Addeass: <br /> b.Phone: d.Phone: .� <br /> e.Speclal Handling In3irucliuris and Additional Information: <br /> f,O Friable 0 Non-Friable L7 Bottt _ %FrlSble %Non•Friable <br /> OPERATOR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shlpplog name <br /> and are classified,packaged,marked anddabetedlpiacarded,and ere in ell respects in proper condition for transport according to applicablo international and <br /> national governmental rog0latlons. <br /> g,Operator's Name and TiUe_(Pffnt h.Si"nature• i.Date ~ <br /> *Operalor refers to the company which owns,teases,operates,controls,or supervises the facility being demoll0ed or renovated,or the demolition nr <br /> renovation operation or both <br /> REV Oil 14 RETURN TO OPERATOR RS-F1 IA <br />