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NO-HAZARDOVI SPECIAL WASTE t& AS13ES S MANIFEST <br /> if waste is asbestos waste,complete Sections 1,It,m and W. 29652 <br /> }© r� <br /> If waste is lye asbestos waste,complete only Sections 1,II L and 111. No. 9 6 5 2 7 <br /> • a � r <br /> a. Generator Name., <br /> meitre° wGilS q <br /> '4106' r b. Generating Location <br /> c. Address AY /Yf d ly J f• d. Address: <br /> e. Phone No.: ! 7- i d�f� <br /> f. Phone No.: <br /> If owner of the generating facility differs from the generator,provide: <br /> g. Owner's Name; h. Owner's Phone No.: <br /> i. BFI WASTE CODE U EyEall <br /> Containers DM-METAL DRUM f DP-PLASTIC DRUM <br /> j. Description of Waste: L Ukt f 4 r`'I n 4 f pf �k. Quantit B -BAG <br /> Units No. TYPE RA -6 MIL.PLASTIC BAG <br /> or WRAP <br /> 0 1 Fn <br /> T -TRUCK <br /> O -OTHER <br /> 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 <br /> any applicable state law,has been properly described,classified and packaged,and is in proper condition for transportation according to P -POUNDS <br /> applicable regulations;AND,If the waste is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Y -YARDS <br /> Restrictions,I certify and warrant that"waste has been treated in accordance with the requirements of 40 CFR Part 266 and is no longera M' -CUBIC METERS <br /> hazardous waste a defined by 40 CFR Part 261. Ys -CUBIC`YARDS- <br /> E <br /> !C Y x�{(C J �' 4t�"°`�I t! D 1 O OTHER <br /> Generator Authorized Agent Name Signature Shipment Date <br /> W ..s=--y e-,.ea'•` 'may,"-`t �- •"- <br /> - -'� <br /> TRANSPORTERI 5TRANSPORTER II <br /> a. Name: 7 U t )---�`�_ h. Name: <br /> b. Address: . •—•--- i. Address: <br /> c. Driver NamefTitie: j. .Driver NamelTrlle: <br /> PRINTfry?F _ <br /> d. Phone N e. Truck No.: f F) PRINTMPE <br /> k. Phone No-: I. Truck No.: <br /> f. Vehicle License Nd/State: m.Vehicle License No./State: <br /> Acknowledgement of Receipt of Materials. Acknowledgement of Receipt of Materials. <br /> � 9 <br /> Driver si paters— n• <br /> _ ver <br /> i maid le <br /> n i nature <br /> ment Date <br /> a. Site Name: �J F� I/ a S ea Ku�t c. Phone No.: <br /> b. 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 /> f � <br /> Name o1 Auswnzed Agora Signature ReWrpt Oats <br /> a. Operator's•Name: <br /> b. Operators'Phone No.: <br /> c. Operator's'Address: �. <br /> d. Special Handling Instructions and additional information: <br /> All <br /> OPERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described shove by proper stripping name end are classified, <br /> packed,marked,and labeled,and are in all respells in proper condition for transport by highway according to applicable intemationat and government g regulations. <br /> e. Operator's'Name&Title: <br /> e <br /> Pnrrviype - Y Opners signature - <br /> f, Name and Address Date <br /> of Responsible Agerpy: <br /> 0 <br /> g.❑ Friable; ❑ Non-friable; ] Both_ ^_ %friable %nontriabie <br /> 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. <br /> REORDER ONLY THROUGH BR/UARCOCONTRACT RETURN TO GENERATOR ® 260-MIDSs3 <br />