Laserfiche WebLink
t REPUBLIC NON-HAZARDOUS SPECIAL WASTE &ASBESTOS MANIFEST <br /> ,t <br /> SERVICES <br /> 1588484 If waste Is asbestos waste,complete Sections I,It.la and IV <br /> If waste Is NOT asbestos waste,complete Sectlons I,II and ill <br /> ' I. GENERATOR (Generator completes la-r) <br /> a.Generator's US EPA ID Number b.Manifest Document Number o.Page 1 of <br /> NIA <br /> d.Generator's Name and Location: e-Generators Mailing Address: <br /> Neil 0.Anderson&Associates Neil O.Anderson&Associates <br /> 9D21ndmirial Way 902 industrial Way <br /> I.Phone: Lodi,CA 86240 208-3@7$701 g.Phone: Lodi,CA 86240 209-387.3701 <br /> If owner of the generating facility differs from the generator,provide: <br /> ' <br /> In.Owner's Name: i.Owner's Phone No.: <br /> j.Waste Profile# k.Exp.Date I.Waste Shipping Name and EL <br /> Conialners n.Total o.Unit <br /> Description No. Type Quantity WWol <br /> ' 420IW42 4011015 Sell � Drums <br /> GENERATOR'S CERTIFICATION: I hereby certify that the above named material is not a hazardous waste as defined by 40 CFR 261 or any applicable <br /> state law,ban been properly described,classified and packaged,and Is In proper condition for transportation according to applicable regulatiom;AND,if this <br /> waste is a treatment residue of a previously restricted hazardous waste subject to the land Disposal Restrictions.I certify,and warrant that the waste has <br /> been treated In accordance with the requirements of 40 CFR 268 and Is no longer a hazardous waste as defined by 40 CFR 261. <br /> .Generator Authorized Agent Name Print .Signature r.Date <br /> ' II. TRANSPORTER Generator completes Ila-b and Transporter completes Itc-e <br /> a.Transporter's Name and Address: <br /> Nell d' fiV1 Golf>ol d' f sSS e Alf <br /> q0a- znd�i54fic1 W�'(rGaAlf tR `a3-dye <br /> ' b.Phons: u1 36�'3d1 <br /> c.Driver Name Print d.SIure e.Date <br /> t III. DESTINATION (Generator complete Illa-c and Destination Site completes Ilid-g) <br /> e.Disposal Facility and Site Address: 4Vea <br /> C. E Number d.Discrepancy Indication Space: <br /> Forward Landfill <br /> 9909 S.Austin Rd. <br /> 1 Manteca,CA 86330 <br /> I hereby certify that the above named to th t w d e e fore do Is true ac <br /> e.Name of Authorized A ent Print .Date <br /> IV. ASBESTOS (Generator completes IVa-f and Operator co lets Ng-1) <br /> a.Operator's Name and Address: c esponsibie Agency Name and Address: <br /> b,Phone: d.Phone: <br /> e.Special Handling Instructions and Additional Information: <br /> ' f.❑ Friable ❑ Non-Friable ❑ Both %Friable %Non-Friable <br /> OPERATOR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name <br /> and are classified,packaged,marked and labeled/placarded,and are In all respects in proper condition for transport according to applicable international and <br /> national governmental regulations. <br /> eralor's Name and Title Prinl I h.Signature 1 I.Date <br /> -operator refers to the company which owns,leases,operates,controls,or supervises the faculty using demolished or renovated,or the demolition ar <br /> renovation operation or both <br /> REV 12110 DESTINATION RETURN RS-F11A <br />