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.,. ,. NflN-FAARD®1° SPECIAL'WASTE & ASBES_ � S MAN � <br /> i - - � (FEST <br /> If waste i5 asbestos waste,complete Sections I,IT,III and IV. I <br /> If waste is N-0-1 asbestos waste,complete only Sections 1,11 and III. N o• 296506 <br /> � b. Generating Location: <br /> c. Address <br /> Andress: <br /> t r✓ <br /> I .s <br /> I e.,Phone No.: Ph <br /> II one No.: <br /> If owner of the generating facility differs from the generator,provide: <br /> I I <br /> I <br /> g Owner's Name: h. Owner's Phone No.: -. <br /> i. BFI WASTE CODE IVP <br /> 9 Containers DM-IME'TAL DRUM <br /> DP-PLASTIC DRUM <br /> j. Description of Waste O. B BAG <br /> k. Quant* rills No. TYPE I BA -&MIL.PLASTIC BAG <br /> or WRAP <br /> f T b -TRUCK <br /> j -OTHER. <br /> GENERATOR'S CERTIFICATION: I hereby certify that the above named material Is not a hazardous waste as defined by 40 CFA Part 261 or UNITS' l <br /> any applicable state law,has been properly described,classified and packaged,and is In proper condition for transportation according to P -POUNDS <br /> applicable regulations;AND,it the waste is a treatment residue of a ' <br /> previously restricted hazardous waste subject to the Land Disposal Y -YARDS <br /> Restrictions,f certify and warrant that the waste has been treated in accordance with the requirements at 40 CFR Part 266 and is no longer a M° -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261. <br /> Y' -CUBIC YARDS ? <br /> � O -OTHER r �4 t <br /> Generator Authorized Agent Namee Signawre Shipment Date - <br /> TRANSPORTERI� TRANSPORTER II <br /> S ;k <br /> a. Name; trve h. Name: <br /> b. Address: i. Address: <br /> c. DriverName/Tide: j. .Driver.Name ile •'.� '- <br /> pRINT/FYPE ARINTlfYPE -------------------------- <br /> f <br /> d. Phone No.: e. Truck No.: / CJ 1 k- Phone No.: <br /> I. Truck No.• <br /> I. Vehicle License No./State: m.Vehicle License NoJState:' <br /> Acknowledgement of Receipt of Materials. Acknowledgement of Receipt of Materials. <br /> 9. <br /> 10=hover n-" . <br /> Shl Ont Date rimer S nature _ sn'merit Date <br /> — <br /> a. Site Name: r 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 /> f <br /> Norrie of AkAhorizad Agent SigrraNre Receipt Date . <br /> •r <br /> a. Operator's'Name: b. Operators-Phone No <br /> c. Operator's'Address: <br /> d. Special Handling Instructions and additional information; <br /> OPERATOR'$CERTIFICATION: I hereby declare that the contents of this consignment are,fully and accurately des cribod above by proper shipping name and are class <br /> packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and government regulations. died, <br /> e. Operators"Name&Title: <br /> Pnnt/TypO - Operators Signature hate <br /> f. Name and Address <br /> of Responsible Agency: <br /> g.❑ Friable; ❑ Non-friable; ❑ Both %friable %nonfriable <br /> �operatorrefers to the company which owns,leases,operates,controls,or supervises the facility being demolished or renovated,or the demolition or renovation operation,or both. <br /> REORDER ONLY THROUGH BFf/U CO CONTRACT <br /> cy RETURN TO GENERATOR ® ?ao-yzoessa <br />