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! NON-HAZARDQU! IPECIAL WASTE & ASBEST i MANIFEST If waste is asbestos waste,complete Sections I,H,IIT and W. No.ark gt9�+ v�O If waste is 2 J D 1G r - 1�asbestos waste,complete only Sections I,n and M. v Ykr�k�.•:« :_:- '._ :. � '._ . _, ..''� _._�. .14^«S'.... ...... Y'.��9'�N;RFi.9hei[ �.�«. �.�. �....es..., �Jl_.—�.� ��.� __r�� a a. Generator Name: i s-� irAt b. Generating Location: y c. Address a CI 115 i F M604 S�rEf _ d. Address: SrtoLt',�-nr.r . Clf� r'152t��j e. Phone No.: Z09 - 46-7- /O C 0 __^ f. Phone No.: If owner of the generating facility differs from the generator,provide: g. Owner's Name: h. Owner's Phone No.: TYOE i. BFI WASTE CODE A (I 4 Q E S Containers DM-METAL DRUM DP-PLASTIC DRUM ii B -BAG j. Descriplion of Waste: t r - O 1 k. Quanti I ( Units No. TYPE BA -6 MIL,PLASTIC BAG t © MF O -OTHER or WRAP GENERATOR'S CERTIFICATION: I hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Pan 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 Restrictions,1 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 hazzarrdous waste as defined by 40 CFR Part 261. q Ya -CUBIC YARDS !>r. �y�1��}fL �CNY� 3 t O -OTHER Generator Aulhorized Agent Name Signature Shipment Date C �.. .. - t."' .:_.. TRANSPORTERI TRANSPORTERII a. Name: �' �� tylrk'l h. Name: b. Address: a� (� �� ]U i � i. Address: { c. Driver NamelTide: t 0 WC, j. oriver Name/rale: PRINFlTYPE PRIN rrrYPE l d. Phone No.: 7�� '-,7ZI e. Truck No.: 7= k. Phone No.: 1. Truck No.: I. Vehicle License No./State! 9 &01/01/ f m.Vehicle License No./State: Acknowledgeii of Receipt Materials. Acknowledgement of Receipt of Materials. cehror a shipment Date _ Uiiver signature Sh'ment data a. Site Name: 6f- 7- Vol SC P c. Phone No.: b. Physicai 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. f. Name or Authorized Agent signature Race pt Date a. Operators'Name: b. Operator's'Phone No.: c. Operators"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 classifiii 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: PrkwType operaWs slghature Data f. Name and Address of Responsible Agency: g. ❑ Friable;`❑ Norf-friable; ❑ Both %friable %nonfriable Operator refers to the company which owns,leases,operates,controls,or supervises the facility being demolished or renovated,or the demolition or renovation operation,or both. REORDER ONLY THROUGH BFI I UARCO CONTRACT RETURN TO GENERATOR ® 260-720B eta