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0 <br /> NON-HAZARDOUS SPECIAL WASTE & ASBESTOS MANIFEST <br /> Ifwaste is asbestos waste, complete Sections I, 11, III and IV No. 779936 <br /> If waste Is NOT asbestos waste, complete only Sections I, 11 and III <br /> Section T. GENERATOR (Generator completes all of section I) ; <br /> a Generator Name _ --' _ - -- b Generating Location <br /> c Address - ~� d Address ' <br /> e Phone No ` { `� t } ` 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 /> TYPE <br /> - r, <br /> BFI WASTE CODE 1* r = r f e d f L Containers DM-METAL DRUM <br /> Bp -PLASTIC DRUM <br /> B -BAG <br /> 1 Description of Waste k uantity Units No TYPE BA -6 MIL PLASTIC BAG <br /> or WRAP <br /> i T -TRUCK <br /> O -OTHER <br /> GENERATOR S CERTIFICATIONII hereby certtly that the above named material is not a hazardous waste as defined by 40 CFR Part 261 UNITS <br /> or any applicable slate law,has been properly described,classified and packaged and is in proper condition for transportation according to P -POUNDS <br /> /cable regulations,AND,If the waste is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Y -YARDS <br /> clions I certify and warrant that the waste has been treated in accardan6e with the requirements of 40 CFA Part 268 and Is no longer M3-CUBIC METERS <br /> ardous waste as defined by 40 CFR Part 261 s � < Y3 CUBIC YARDS <br /> ` O -OTHER <br /> ! i <br /> Generator Authorized Agent Name Signa(ure - _ Shipment Date <br /> Tt8rt8pMlet t COrlypt9te 6g <br /> Seaton II TRANSPORTER(Generator complete ad, Transporter n complete i,-n) .- r f <br /> TRANSPORTERI TRANSPORTERII <br /> a Name r h Name <br /> b Address r ' ' = - I Address <br /> c Driver Name/Title j Driver Name/Title <br /> PRINT!TYPE PRINT!TYPE <br /> d Phone No = r - �` e Truck No / k Phone No I Truck No <br /> I Vehicle License No /State 1 ` f �r m Vehicle License No /State <br /> Acknowledgement of Receipt of Materials Acknowledgement of Receipt of Materials <br /> g Driver Signature Shipment Date Dover Signature shipment Date <br /> Section III DESTINATION mpenerator completes a-d.deslirtattan'site otmrpfetets e-f; <br /> a Site Name c Phone No <br /> b Physical Address d Mailing Address <br /> e 0epancy 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 Name of Authorized Agern Signature Receipt Date <br /> secdoRx ��- �h�t " ASBESTOS(c� g.�` a "z <br /> „tea,..�, t w '6""2 m n e_7 <br />