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NON-HAZARdouU� PECIAL WASTE & ASBEST,,� MANIFEST If waste is asbestos waste,complete Sections y 11,III and 1V. o. 0 If waste is NOT asbestos waste,complete only Sections 1,11 and Ili. NN a. Generator Name: } f b. Generating Location: c. Address f Fre,,I9.A, - _ d. Address: e. Phone No.: ;LU/ C16-7 t. Phone No.: If owner of the generating facility differs from the generator,provide: g. Owner's Name: h. Owner's Phone No.: DLPE i. BFI WASTE CODE 7 0 S l (�f Containers DM-METAL DRUM DP-PLASTIC DRUM a' B -BAC, j- Description of Waste: /"/p� �Al 'JIYA47 r alh,A 171-'V k. Quantity units No. TYPE BA -6 MIL-PLASTIC BAG or T TRUCK -OTHER WRAP 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 desonbed,classified and packaged,and is in proper condition for transportation according to P -POUNDS applicable 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 treated in accordance with the requirements of 40 CFR Part 268 and is no longer a M' -CUBIC METERS hazardous waste as defined by 40 CFR Part 261. Y3 -CUBIC YARDS �Z - C,� Q O -OTHER Generator Authorized Agent Name Sidnature Shipment Date ._�. •v. _- s_,..:-r.,e-�-- -' _ ,-.mss ,-� ..,� - _ — TRANSPORTERI TRANSPORTERII a. Name: 6t W4 C- _ rh. Name: b. Address: ')Q 14' w-��((LA/x /� 1�Z Z � i, Address: Lu rL C U f 4 c. DriverNamelTtle: l�,ee�_sRC �.ls: j. DriverNamell'itle: t P"T/rYPE PRWTr YPE - r d. Phone No.: ]? 71� J e. Truck No-: n k. Phone No.: 1. Truck No.: I. Vehicle License NoJState: ! f �f�' m.Vehicle License No./State: Acknowledgement of Receipt of Materials. c' Acknowledgement of Receipt of Materials. 2� 9- 1 n. m shipment Date Dmrer Signature Shl ent Ueta a. Site Name: Azi, J� c- Phone No.: b. Physical Address: d. Mailing Address e. Discrepancy Indication Space: I hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate. 1 I. Name at Aulhonzed Agent signature Receipt Date ' .. `a1"- .'i '.. ... .: '. _ •'i. ': - :..;. -:: _.`. .fit - .,..;k:.a �ijf':. - .;�.cii'., a- Operator's`Name: b. Operators'Phone No.: c. Operators'Address: d. Special Handling Instructions and additions!information: OPERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fu#y and accurately described above by proper shipping name and are classified, packed,marked,and labeled,and are in all respects in proper condition for ransport by highway according to applicable international and government regulations. e. Operators'Name&Tire: Prtnt type ovemor's signature bate f. Name and Address of Responsible Agency: ' g. ❑ Friable; ❑ Non-friable; ❑ Both %friable %nonfriable Operator rafters to the company which owns,Ieaws,operates,controls,or supervises the facility being demolished Ilr renovated,or the demolition or renovation operation,or both. REORDER ONLY THROUGH BFI I UARCO CONTRACT RETURN TO GENERATOR ® 290-7208 5W