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r NON•HAZAWOU; SPECIAL WASTE & AS8ES7,,..,3- MANIFEST If waste is asbestos waste,complete Sections I,IL III and Iv. If waste is NOT asbestos waste,complete only Sections I,Il and III. NO.2 86,510 a. Generator Name: r M09AKQ 7 b. Generating Location: c. Address A -L. ER Fmn e d. Address: - )) i ff� e. Phone No.:�z ^'0eS�� h '7--J Cr r' ri f. Phone No.: If owner of the generating facility differs from the generator,provide: g. Owner's Name: h. Owner's Phone No.: PL I. SR WASTE CODE O f C� ] �/ U Containers DM-METAL DRUM f f 1 1 ! OP-PLASTIC DRUM B -BAG +1? j. Description of Waste: k. Quantityunits No. TYPE BA -6 MIL.PLASTIC BAG or= HMMO T TRUCK OTHER WRAP GENERATOR'S CERTIFICATION: I hereby certify that the above named material is not a hazardous waste as defined by 44 CFR Part 261 or UNIT5 any applicable state law,has been properly described,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 44 CFR Part 261. Y' -CUBIC YARDS OTHER Generator Authorized Agent Name Signature Shipment Date T ANSPORTER I TRANSPORTER H a. Name: / h. Name: b. Address: 'ja6w f 4/ zel i. Address: c. Driver Name(ritle: lC L!/NL j. Driver Name<Ttle: PRtNTfTYPE �� PRINTrFYPE d. Phone No.: e. Truck No.: LIZ k. Phone No.: I. Truck No.: I. Vehicle License NoJState: C"W m.Vehicle License NoJState: Acknowledgement of Receipt of Materials. Acknowledgement of Receipt of Materials. —...__ 01<711 Ism n. s er t DareDrNer aigulure sn m Date a. Site Name; 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. a f Name of Authorized Agent Signature Reoerpt Date a. Operators"Name: b. Operator's'Phone No.: c. Operator's'Address: d. Special Handling Instructions and additional information; OPERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully 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: Printlrype - - operators signature Daze I. Name and Address of Responsible Agency; g. ❑ Friable; ❑ Non-friable; ❑ Both %triable %nonfriable Operaloi re't@,s to the company which owns,leases,operates,controls,or supervises the facility beinb demollshed or renovated,or the demolltlon or renovation operation,or both. REORDER ONLY THROUGH BFI f UARCO CONTRACT RETURN TO GENERATOR ® 2M720e sass