WORK PLANS - Laserfiche WebLink

Home Browse Search

l NON-HAZA DOUI7sPIECIAL WASTE & ASBES'f,S MANIFEST If waste is asbestos waste,complete Seotions I,II,In and rv. If waste is NdT asbestos waste,compiete only Sections I,H and III No•,2 J 6 5 03. RIN a. Generator Name: b. Generating Location•": I c. Address ��✓h d. Address: e..Phone Na,: ;Z,,:;' to� (; f. Phone No.: If owner of the generating facility differs from the generator,provide: g. Owners Name: h. Owner's Phone No.: I. BFI WASTE CODE TYPE g 0 / (� Containers DM-METAL DRUM DP-PLASTIC DRUM k N C ��l J a -BAG i 1- Description of Waste: !�- t_k, Wiinti Units No. TYPE BA -6 MIL,PLASTIC BAG or WRAP I O -OTHER . GENERATOR'S CERTIFICATION: I hereby certify that the above named material Is not a hazardous waste as defined by 40 CFR Part 261or UNITS. any applicable state law,has been property described,classified and packaged,and is in proper condition for transportation according ip P -POUNDS applicable regulations;AND,itthe waste Is a treatment residue of a previously restricted hazardous waste subject to the LandDisposal Y -YARDS Restrictions,I certify and warrant that the waste has been treated in accordance with the requirements of 40 GFR Part 266 and is no longer a M' -CUBIC METERS hazardous waste as defined by 40 CFR Part M. .. a F Y CUBIC YARDS _ '� :. O OTHER � : Ge erator Authorizetl^Rgen1�11ar�a Signature- Shipment Date' TRANSPORTERI TRANSPORTER CI a. Name:.. h. Name: i b. Address: r ! { is Address: r fJ G—Driver-Namel-Title:, fy_i1i - -..___ ... . -- , -— j.'Drtvei Name/Title- —' - _ P INT ME..k -i PRINUTYPE d. Phone No.:_- _ ` F t a *�ruck iVo.: k. Phone No.: Truck.i I, ruc No.: f. Vehicle License NeJState: m.Vehicle License NoJState: know dgement of Receipt oi'Materials. Acknowledgement of Receipt of Materials. �Jg' it Driver n ' dn- Driver Si ature Shipment Date ' a. Site Name: e F J+r d 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 k wledge the foregoing is true and accurate. f. G`f� / Name of Authorized Agent Signature �l Receipt Dais .- ' 0' I' a. Operator's'Name: b. Operator's'Phone No.: c. Operators`Address: d. Special Handling Instructions and additional Information:. 4 OPERATOR'S CERTIFICATION: I hereby declare that the contentsof this Consignment are frilly and accurately described above by proper shipping name and are classified, packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and government regulations. e, Operators'Name&Title: t. Name and Address PrmuType Operetors Signahrm Dare ' of Responsible Agency: g. ❑ Friable; ❑ Nan-friable; ❑ Both %friable 9b nonfriable L, ,I ". Operator'iefem to the company which awns,leases,operates,caMrola,or supervises the facility being demolished or renovated;or the demolition or renovation operation,or both. REORDER ONLY THROUGH OR l UARCO CONTRACT RETURN TO GENERATOR - ® 260-720e SM i