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1 NOWHAZAR66 SPECIAL WASTE & ASBEtSttttll�A MANIFEST .. 11 If waste is asbestos waste,complete Sections 1,11,III and'IV. . Ncy I If waste is N T asbestos waste,complete only Sections 1,11 and III.ON ��1 .. a' "s x ta t & rz Cw/�� /" kT b. Generating Location: a. Generator Name: r g c. Address 7p T d. Address- e. Phone No.: f. Phone No.: If owner of the generating facility differs from the generator,provide: g. Owner's Name: h. Owner's Phone No.: TYPE r '; #. BFI WASTE CODE li J 7 4s� Containers DM-'METAL DRUM t, DP-PLASTIC DRUM B -'BAG j. Description of Waste: 1 .D iQ�I�%�Jl�t�P p I/ k. Ouanti Units No.. TYPE BA-6 MIL.PLASTIC 13AG > or WRAP T -TRUCK O -'OTHER GENERATOR'S CERTIFICATION: I hereby certify that the above named material Is not a hazardous waste as defined by 40 CFR Part 261 or UNITS '€ any applicable state law, has been properly described,classified and packaged,and is in proper condition for transportation according to P -POUNDS applkable regulations;AND,If the waste is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Y -'YARDS Restrictions,I certify and warrant that the waste has been cre71'. ' accordance with the requirements of 40 CFR Pan 268 and is no longer a M' -'CUBIC METERS hazardous waste as defined by 40 CFR Part 261. Y' -iCUBJC YARDS Min 11c1I�K0 k 0 -(OTHER Generator Authorized Agent Name Signature Shipment Date - TRANSPORTERI TRANSPORTER II ' a. Name: el_.0 Qf7'IF/X Era 41•f�F�l rf� fi h`..Name: b. Address: i. Addre s;:-. c. Driver Name/Title: t G Jr'�� 7 j. Driver'NameMtie: PRfNTRYpr PRINTftYPE d. Phone No.: 76-z 4;�/ ®, Truck No.: r4k. Phone No.: i. Truck No.: - L Vehicle License NoJState: S�Sf� ��G _ C_-y , m.1 chicle License-No./State: Acknowledgement of Receipt of Materials.' kknowledgement of Receipt of Materials. i .,n .. Llg. n. flrlver Si ature Sh"mem nate - Dauer si aWre :l • Shi meet Pate u a. Site Name: C+ c. Phone No.- 1 L b. Physical Addreis: d. Mailing Address e. p€screpancy I rdication Space: hereby certf that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate. i ### Name at Authorized Agent Signature Fl mop Date a. Operator's'Name: b. Operator's'Phone No.: c. Operator's'Address: ! d. Special Handling Instructions and additional information: t OPERATOR'S CERTIFICATION: I herebygclare that ats Elie conteof this consignment era fully and accurately described above byprgper shipping name and are classified, packed,marked,and labeled,and are in all. -spects in proper condition for transport by_bighway according to applicable international and govemment regulations. e. Operator's'Name&Tdle: _ P,inVTYAe' Operators Signature Date . f. Name and Address of Responsible Agency: g. ❑ Friable; ❑ Non-frlable; ❑ Both %friable %nonfriabie " Operator rs!ers to the company which owns,leases,operates,controls,or supervises the facility being demolished or renovated,or the demolition or renovation operation,or bath. REORDER ONLY THROUGH BFI lUARCOCONTRACT RETURN TO.GENERATOR' ® '