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G. <br /> NON-HAZARDOUS SPECIAL"S WASTE & ASBES^IS MANIFEST <br /> If waste restos waste,complete Sections;,II,R1 and IV. <br /> If waste is NOT asbestos waste,complete only Sections 1,Hand M. No•2$65 2 9 <br /> t00x. a mm <br /> i a. Generator Name: f t✓���}} f J r T T h.�Generating Location: , <br /> I c. Address Ye_MIA <br /> d. Address: <br /> i <br /> i e. Phone No.: <br /> I. Phone No.: <br /> If owner of the generating facility differs from the generator,provide: <br /> 3 g. Owner's Name: d <br /> h. Owner's Phone No.: <br /> i. BFI WASTE CODE 0 S c� f q f E - <br /> i 1 D 1f Containers DM-METAL DRUM <br /> DP-PLASTIC DRUM <br /> j. Description of Waste: L rfM 6t 7st+LI a t S a! k, Quanti B -BAG <br /> Units No.''; TYPE BA -6 MIL,PLASTIC BAG <br /> T -TRUCK WRAP <br /> III���JJJ <br /> tO -OTHER <br /> t GENERATOR'S CERTIFICATION: I hereby cerlity that the above named material is not a hazardous waste as defined by 40 CFR Pan 261 or UNIT <br /> any applicable state law,has been propedy described,classed and packaged,and is in proper oondtlion for transportation according to _ <br /> applicable regulations;AND,If the waste la a treatment residue of a previously restHp -POUND$tted hazardotra-waste subject to the Land Disposal Y Y <br /> Restrictions,I certify and warrant that the waste has been treated in accordance with the requirements of 4e CFR Part 266 and Is no longer a - ARDS' <br /> hazardous waste as defined by 40 CFR Part 261. :r S M' -CUBIC METERS <br /> I /� /� Y3 -CUBIC YARDS <br /> ! 1V r U (] r G O -OTHER' <br /> Generator Authorized Agent Name Signature <br /> f Shipment Date - <br /> - <br /> TRANSPORTER'I � TRANSPORTER II <br /> - <br /> ' <br /> Ib. Address: � - - <br /> i. Address: <br /> �A - <br /> - c..Driver NameTtle: I. <br /> pnr m_ar= <br /> j. 'Driver Mamelrrno: ° 4 <br /> d. Phor No.:' Truck No.: PniNTmPe <br /> 4 k..Phone No.: i. Truck No.:. <br /> ' f. Vehidle License No.(State: <br /> Acknowledgement of Receipt M e ials. m.Vehicle License No./State: <br /> t Acknowledgement of Receipt of Materials. <br /> 9- r <br /> Dm r <br /> ,. Shi ment to .Drivers nature <br /> r _ _ Shi merit tate <br /> a. Site Name: <br /> c. Phone No.: <br /> b. Physical Address: <br /> d. Mailing Address <br /> e. Discrepancy Indication Space: <br /> I, 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 /> �w - <br /> f. <br /> I.Name m Authorized Agent <br /> Signature <br /> i5I Recefpf bate _ <br /> a,,Operators'Name: n <br /> I b. Operator's'Phone No.: <br /> C. Operators"Address: <br /> d.''Special Handling Instructions and additional information: <br /> OPERATpR 5 CERTIFICATIOk: thereby declare that dte contents of this eonslgnment are fully and accurately described aboveproper sh€ n name and are classified, <br /> packed,marked,and labeled,and are in all respects in proper condition for transport by highway accordingto shipping <br /> applicable international and government regulations. <br /> a. Operators'Name&Tide: <br /> PdlsVrype <br /> I. Name and Address Date <br /> of Responsible AgenrsTr: <br /> 9. Friable; ❑ Non-fr€able• ❑ Both q friable <br /> ! _ X nonfriable <br /> 'Operator refers to the oompany which owns,leases,operates,controls,or supervises the facility being demolished or renovated,Or the demolition or renovation <br /> 'I operation,or both. I <br /> REORDER ONLY THROUGH BFI/UARCO CONTRACT` } <br /> f RETURN TO GENERATOR I® zaerm6y a i <br />