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w NON-HAZABDOV SPECIAL WASTE & ASBESS MANIFEST <br /> a <br /> if waste'is asbestos waste,complete Sections I,II,III and IV. ++� <br /> If waste is Q asbestos waste,complete only Sections I,II and III. No. L S B 5 1 2 <br /> a. Generator Name:�C-I'R E t,,,,A I S MA R KL v $ <br /> b. Generating Location: <br /> c, Address <br /> Address: <br /> 5Z <br /> ! i } <br /> e_ Phone No.:. `` ���- / Q�� f. Phone No.: <br /> If owner of the generating facility differs from the generator,provide: <br /> g. Owner's Name: <br /> h. Owner's Phone No.: <br /> i. BFi WASTE CODE ( Q PE <br /> Containers LE <br /> METAL DRUM <br /> c LASTIC DRUM <br /> j. Description of Waste: T I S k. QuantityAG <br /> tfnAs' Na. TYPE MIL.PLASTIC SAG <br /> Il © or WRAP <br /> RUCK <br /> THER <br /> GENFRATOR'S CERTIFICATION: I hereby certify that the above named material is not a hazardous waste as tlefined by 40 CFR Part 261 or UNITS <br /> any applicable slate law,has been property described,ciassfied and Packaged,and is;;in proper condition for transportation according to - p -POUNDS <br /> applicable regulations;AND,if the waste fa a treatment residue of a previously restrtcted hazardous waste subject to the land Disposal Y -YARDS <br /> Restdctions,I certify,and warrant that the waste has been t ated in accordance with the requirements of 4o CFR part 288 and is no longer a M' -CUBIC METERS <br /> ' haze7ijbpaste as defined by 40 CFR Part 261. <br /> �'�'�"� �1 -1 Y3 -CUBIC YARDS <br /> ` I 2 O -OTHER <br /> Generator Authorized J <br /> gent Norrie Signature _ <br /> Shipritent Date <br /> T NS TERI <br /> a. Name: <br /> TRANSPORTERII i <br /> � 1 <br /> h. Name: # <br /> It. Address: <br /> II,Address: <br /> t; <br /> c,-DriverNameLiitle:-. <br /> k ti PE <br /> d. Ph a No.: ! Truck No.: PRINTMPE [ <br /> k. Phone No.: I. Truck No.; <br /> L Vehic License NoJState: 4 <br /> r <br /> Acknowledgement of Rei m_.Vehicl&License No./State: <br /> 9 t of Nf�terials. Acknowledgement of Receipt of Materials. <br /> 9- if ; <br /> Driver Si nature ! n.. . <br /> xis: ._c� meet Da 1 Driver SI nature ! <br /> r� a Sh ant nate <br /> a' <br /> a. Site Name: 8)F 5 <br /> c. P . <br /> hone N�.: <br /> It, Physical Address: <br /> ' d. Matting Address <br /> j: <br /> e. Discrepancy Indicatlon Space: <br /> f <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 /> Noma rN quttrorized Agent ' <br /> Slgnalure <br /> tam - <br /> �� <br /> f a. Operator's•Name: ° <br /> b. Operator's*Phone No.: <br /> c. Operator's'Address: <br /> d. Special Handling Instructions and additional information: <br /> OPERATOR S CEt1T1FlCAtION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, <br /> packed,marked,and labeled,and are in aft rospects in proper condition for transport by highway according to applicable international and goyemment regulations. <br /> ` e. Operator's`Name&Title: <br /> Primrrype - - <br /> f_ Name and Address oaaramra s gnatu a Date <br /> of Responsible Agency: <br /> g. ❑ Friable; ❑ Non-friable, ❑ Both %friable %nonfriable <br /> t ' Operator refers fo the company which owns,leases,` - <br /> operates,controls,or supervises the facility being derriofisiietl or renovated,or the demolition or renovation operation,or both. - <br /> REORDER ONLY THROUGH BFI/UARCO CONTRACT <br /> __-- RETURN TO GENERATOR ® zeo7zoe5e3 <br />