WORK PLANS - Laserfiche WebLink

Home Browse Search

�. NONE I RDOU�SPECIAL WASTE A ASBEST� MANIFEST If waste is asbestos waste,complete Sections 1,IL III and IV. NO.2 S G r 11 If waste is NOT asbestos waste,complete only Sections 1,11 and III. [7:3 e� - c a. Generator Name: (;M wA I) 0 A A X f,Jb. Generating Location: c. Address y 1 Q O FA ST S-A (fEi d, Address: STocK -yCA ,200) e. Phone No.:_ �G` LJ 1 ! Q G f. Phone No.: If owner of the generating facility differs from the generator,provide: g. Owner's Name: hh. Owner's Phone No.: `ALJ j � j LE I. BFI WASTE CODE Containers DM-METAL DRUM J � ( OP-PLASTIC DRUM B -BAG j. Description of Waste: con4 7z p k. Quanti units No. TYPE BA -6 MIL.PLASTIC BAG MO / F--f� 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 applicable regulations;AND,if the waste Is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Y -YARDS Restnctions,I certify and warrant that the waste has been tr ad In accordance with the requirements of 40 CFR Part 268 and is no longer a M' -CUBIC METERS hazardous waste as defined by 40 GFR Part 261. Ys -CUBIC YARDS I✓`A CVIE Aq 8 c O -OTHER Generator Authorized Agent Name Ignature Shipment Date -- ..... -.._.. - a �• _ 290-M- 910 TRANSPORTER[ TRANSPORTER H a. Name: �� t'1 � uC�s 14,E h. Name: b. Address: I. Address: c. Driver NamerTitle: V11 Tr Driver Namef title: PRINT PRINTrrYPE d. Phone No.: Q e. r uck]No.: k, Phone No.: I. Truck No.: 1, Vehicle License No./State: 1 _ � In.Vehicle License NoJState: Acknowledgement of Receipt of Materials. [� Acknowledgement of Receipt of Materials. g. I f n. Driver r - Shipment Dale Driver Si nature -- ShI ment Date a. Site Name: 1�1 F �N ' 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 m knowledge the foregoing is true and accurate. f. Name of Authorized Agent Signature Receipt Date 90 1 t1:; ; a. Operator's'Name: b. Operator's'Phone No.: c. Operator`s'Address: r d. Sp-,'&l Handling Instructions and additional information: OPER TOR'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. Operator's"Name&Title: PnrwType ^.r. -.., Operators Signature Date f. Name and Address of Responsible Agency: g. ❑ Friable; ❑ Non-friable; ❑ Both %friable _ %nonfriabie CpetatQ(refers to the company which owns,leases,operates;controls,or supervises the facility being demolished or renovated,or the demotltlon or renovation operation,or both. REORDER ONLY THROUGH BFI I UARCO CONTAAC RETURN TO GENERATOR ® 260-T"ssa