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NON-HAZAADOV-4 SPP61AL WASTE & ASOES,.,)S MANIFEST <br /> If waste is asdestos waste,complete Sections t,][1,111 and IV. <br /> If waste is NOT asbestos waste,complete only Sections 1,11 and 1111. -No. 2 96 516 <br /> N. Hq'- <br /> a. 7 <br /> Generator Name: (5, PA A b. Generatin Lcation: <br /> c. Address EA��Tltmoq-t arEE4 Address: <br /> C8 1 or-) <br /> a. Phone No.:- 2 -1 �,09- 9 �0 I a A 1 f'Phone N <br /> It owner of the generating facility differs from the generator, rovide-i <br /> g. Owner's Name; <br /> h. Owner's Phone No.; <br /> i. BASTE CODE <br /> Containers DM-METAM <br /> PA qL DAU <br /> 1 511 DP-PLASTIC DRUM <br /> B -BAG <br /> j, Description ON%- 12% k. ti. Units No. TYPE 13A-0 MIL PLASTIC BAG <br /> © O or WRAP <br /> T TRUCK <br /> 0 OTHER <br /> GENERATOR'S CERTIFICATION: I hereby certify that the above narned material is not a hazardous waste , It, In 2 UNITS <br /> any applicable state law,has been property described,classified and packaged,and is in proper conald nspoltatio according to <br /> applicable regulations;AND,if the waste is a treatment residue of a previously restricted hazardous subject t4 th P -POUNDS <br /> -d in accordance with the requirements of <br /> Restrictions,I cerdty and warrant that the waste has been treated YARDS <br /> hazardous waste as defined by 40 CFR Part 261. a OF Part 266 a d rtwVf)di ViNor CUBIC METERS <br /> Y3 CUBIC YARDS <br /> 70 OTHER <br /> Gene for Authorized Agent Name Signature Shipment Date <br /> 77 <br /> En� <br /> 00 <br /> RJSPORTER I TRANSPORTER 11 <br /> a. Name: h. Name: <br /> b. Address: 2t, I. Address: <br /> C, Driver NamoMtle: <br /> -Ori've r Namen-Itiel- <br /> �Ii�TfrYPE j. FRINTfFYPE <br /> d. Phone Noy.- I S 10 e. Truck No. k. Phone No.; <br /> 1. Vehicle License No./State: <br /> S�te:i T 7�z I. Truck No.: <br /> M.Vehicle License No./State: <br /> Acknowledgement of Recei of Materials. Acknowledgement of Receipt of Materials. <br /> 9- Driver Si n meetL) n. <br /> 7M <br /> -M <br /> a, Site Name: &FfJR <br /> e. Phone No.: <br /> 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 /> Name of Authorized AgeniSignature <br /> Flecelpt Date N_ <br /> a. Operator's'Name: b. Operator's'Phone No.: <br /> c. Operator's'Address: <br /> d. Special Handling Instructions and additional information: <br /> OPERATOR'S Gim"VIMCATION: I hereby declare that the contents of this consignment are fully and accurately described above by:prop�r shippfrib name and—are classified, <br /> packed,marked,and labeled,and are in all respects In proper condition for transport by highway according to applicable international And go*emment regulations. <br /> e. Operator's'Name&Title: Printri-ne <br /> f. Name and Address Date <br /> of Respons"befteAcy: <br /> g.El Friable; L­Non-Non-Mable; El Both %friable <br /> %nonfriable <br /> Operator refers to the company which owns,leases,operates,controis,or supervises the facility being demolished or renovated,or the demolition or renovation operatim,or both. <br /> REORDER ONLY THROUGH BFI/UA9C0 CONTRACT RETURN TO GENERATOR G <br />