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p a <br /> NON-NAZARDOV-1 SPECIAL WASTE & ASBE; ]S. MANIFEST <br /> If waste is asbestos waste,completFections I, Ii4rid IV. <br /> If waste is NOT asbestos waste,complete only SB "Ol s t,II and IU. <br /> a. Generator Name; q <br /> b. eneratin Loc n. <br /> d. ddress: <br /> e. Phone No.: - /` f- hone No.: <br /> If ownei of the generating facility differs from the general ,provi <br /> g. Owner's Name: <br /> h. Owner's Phone No.: <br /> i" SR WASTE CODE Gs n { PE <br /> ® 0 v I y Containers LIM-METAL DRUM <br /> DP-PLASTIC DRUM <br /> j. Description of Waste: k. Quantity Unks No, TYPE BA -6 MIL.PLASTIC BAG <br /> n <br /> or WRAP <br /> I C� �• T -TRUCK <br /> O -OTHER <br /> GENERATOR'S CERTIFICATION: I hereb certify t t the above named material is not a hazardous wast ! <br /> any'applicabfe state law,has been properly ed,classified and - art2 1 t UNITS - <br /> peviously and is a proper oontl'one transpoita a rd;oo to, POUNDS <br /> applicable regulations;AND,If the waste Is a treatment residue of a previously restricted hazartlous waste sub'ect to pps� <br /> Restrictions,I Certify and warrant that the waste has been treated m accordance with the requirements of 40 CFR Part 268 and is no!on era YARD$ <br /> hazardous waste as defined by 40 CFR Part 261. 9 M' -CUBIC METERS - <br /> `�''�� �} Y3 CUBIC YARDS <br /> /! <br /> CYE//)9A V 1 �� O -OTHER <br /> Generator Authorized Agent Name Signature ! <br /> Shipment Date <br /> TRANSPORTER 1 TRANSPORTER II <br /> a. Name: .t� h. Name: <br /> b. Address: iPvl . Address: <br /> i <br /> INTITYPE <br /> j. Driver NameiTitle: 4 <br /> d. P& �•KL!i � e. Truck No.: PRlnrrmPs <br /> If k. Phone No.: I. Truck No.: <br /> f. Vehicle License NoJSti rl m.Vehicle License`No.lStato: <br /> h Acknowledgement of Receipt of Materials" " <br /> 4 Acknowledgement of Receipt of Materials, <br /> k g I' <br /> Driver SI ature <br /> _ - Shl enf Date Omer Sf store <br />' •`� - Shi mein Data <br /> a. Site Name: <br /> ASco C. Phone No.: i <br /> b. Physical Address: <br /> - d. Mai' 9 <br /> 'I <br /> Ila Address <br /> e. Discrepancy Indication Space: I <br /> 14 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 /> r HamadAuawnzed Agent Signature - <br /> _ Receipt Date E <br /> _ - - fi .Ss l <br /> .... �' - <br /> a. Operators'Name: b. Operator's'Phone No.: <br /> c. Operator's-Address: { <br /> d. Special Handling Instructions and additional Information: <br /> OPERATOR S CERT}t iCA710N: I hereby declare that the contents of this consignment are sully and accurately doscdtred above <br /> packed,marked,and labeled,and are in all respects in proper condition for transport by highway aocordin to by Proper shipping galas and are classified, <br /> g applicable international and government regulations. <br /> e. Operator's'Name&Title: <br /> I. Name an�AddresS Pnnvtype operators Signawre oeta <br /> of Responsible Agency: <br /> II g. ❑ Friable; ❑ Non-friable; ❑ Both %friable %nonfrfable <br /> r <br /> Operator refers to the company which owns,leases,operates,controls,or supervlses the facility being demolished or renovated,or the demolition or renovation operation,or both.- <br /> REORDER ONLY THROUGH BFI l UARCO CONTRACT <br /> RETURN <br /> TO GENERATOR <br /> >_. zao-Me&W <br />