WORK PLANS - Laserfiche WebLink

Home Browse Search

*!"*AZ�p11' I SPECIAL WASTE'& ASBEW IS MANIFEST If waste is asbestos waste,complete Sections I,II,III and IV. No-23165 l��11 #� If waste is NOT asbestos waste,complete only Sections I,tI and III. �r�•�� g ' FA- a. Generator Name: 67,Z Vy 44 5 _ b. Generating Location: a Address ��{� �R£ru o t� S Ree} d. Address: STg ,r 4at1 e �t 5Q 05 Qq—i— e. Phone No.: CI L� ,t`E! It. Phone No.: If owner of the generating facility differs from the generator,provide: I� I g. Owner's Name: h._Ownees Phone No.: TYPE is BFI WkS� ipE ® ® `� I 10 9T011 Containers DDm-METAL DRUM P -PLASTIC DRUM i!� S BAG _ j- Description of Waste: Q n 7 M J k, Quantity :units " No. TYPE BA -61MIL.PLASTIC BAG or WRAP t g T -TRUCK. t — 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 r any applicable state law,has been properly described,classified and packaged,and is in-proper condition for transporiatlon 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 - f Restrictions,Ice"and warrant that the waste has been tr ted in accordance with the requirements pf 40 GFR Part 268 and is no longer a M' -CUBIC METERS hazardous waste as defined by 40 CFR Part 261. "' 4w Y3 -CUBIC YARDS -_.. Cjx J� Q y`y O -OTHER Generator Authorized Agent Named Signature Shipment Date TRANSPORTER] TRANSPORTER H a. Name: 1 1�V k) ' h. Name: b. Address: i;' Address: E c..Driver NamefTitle: }nA . :, r j. DriverNarneJTitfe: PRI PE PRINT/'fYPE d. Phone No.: e. Truck No.: �7 k.` Phone No.: I. Trude No.: ! f. Vehicle License No./State: m.Vehicle license No./State:. Acknowledgem of Receipt of Materials. Ackrtowledgemerit of Receipt of Materials. q T p r n. r i- DdvW 1jure,Ipent to Drim Suture Sh' nt Date P a.-Site Name: C. Phone No.: b. Physical Address: d. Mailing Address ! e. Discrepancy Indication Space: I hereby certify.that the above named'mgj�rial has been accept best of my knowledge'the foregoing,is true and accurate. f. Name of Authorized Agent Signature Receipt Date M . $..ti 11 a l a. Operators`Name: f�'Operator's'Phone No.: c. Operators'Address: t d. Special Handling Instructions and additional information: OPERATOR'S CERTIFICATION: t hereby declare that the oontea ment are fully and accurately described above by proper shipping name and are classified, packed,marked,and labeled,and are in all respects in proper conch - 'by highway according to applicable international and government regulations. e. Operators*Name fig Title: Printlrype Operators Sq,awre Date f. Name and Address - I of Responsible Agency: g. ❑ Friable; ❑ Non-triable; ❑ Both %friable %nonfriable ' Operator refers to the company which owns,leases,operates,controls,or supervises the facility being demolished or renovated,or the demolitibrt or renovation operation,or both. REORDER ONLY THROUGH BFI I UARCO CONTRACT RETURN TO GENERATOR ® 260-720 SM