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nun-nA4AhWVU3 SPEGIAL WASTE & ASBESTOS MANIFEST <br /> t _ <br /> If waste is asbestos waste, complete Sections I, II, III and IV No. 7 80 9 4 9 <br /> If waste is NOT asbestos waste, complete only Sections I-II and III <br /> coon I _GENERATOR generator oompieces ali of soman <br /> G for Name <-A l s.'t.J �� �. b Generating Location � E��cY'✓ r" 9— �7 <br /> Address C'� �� t� a C)C VC <br /> ., d Address KZ2 � T/�� ,� 1?4_1//9, <br /> Shone No '� r L— d �� _ f Phone No <br /> caner of the generating facility differs from the generator provide <br /> owner s Name h Owners Phone No <br /> TYPE <br /> 3FI WASTE CODE DM-METAL DRUM Containers DP -PLASTIC DRUM <br /> - , B .BAG <br /> lescnpGon of Waste ! IrL��CC�C`,C!G-/ ��?� k Quandt - unas No TYPE BA -6 MIL <br /> oPWRAP BAG <br /> 0 -OTUCK <br /> HER <br /> iENERATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Part 261 UNITS <br />�r any applicable state law,has been property described classified and packaged and is in proper condition for transportation according to P -POUNDS <br /> pplicable regulations AND,If the waste Is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Y -YARDS <br /> iestrictions,tow*and warrant that the waste has been treated In accordance with the requirements of 40 CFR Part 268 and Is no longer M3-CUBIC METERS <br /> hazardous taste as defined by 40 CFR Part 261 r�y� Y3 -CUBIC YARDS <br /> O -OTHER <br /> 3enerator Authonzed Agent Name ignature Shipment Date <br /> er <br />:tion II TRANSPORTER(Generala complete ate. -r:a <br /> TRANSPORT`E'R I TRANSPORTER II <br /> Qame L l �C_— h Name <br /> i Address <br />)river Name/Title I Driver Name/Title <br /> R N PRINT/TYPE <br />'hone No fa _�-211e Truck No/f 7 �� k Phone No I Truck No <br /> iehicle License No /State ` X m Vehicle License No /State <br /> lcknowledgement of Receipt of Materials Acknowtedgement of Receipt of Materials <br /> i No 8613124 <br /> BROWNING-FERRIS INDUSTRIES <br /> tr i'- ?-1,5T:se I-I t� .:,2 :3 Tie fit :2 <br /> '-t:,a;5 C;sc # ;1! a' I tiC 3. '7n y cr 1aryLa-,di- <br /> -HE, <br /> a- <br /> -HEI REV IJSH <br /> nor-` Opera1c Pi71ZKT r. <br /> Vic t 3i' dP yd Scaje ir, *ala Cru- 4. <br /> USS li: Tare itt: 'Net Wt:y to t r f <br /> G� Actual ul.i Ott # Ur:t E<:EndM <br /> L -11r, L !d dill 11P fl a _ZekI .2u 111 <br /> Sub Totai. 6 103.50 <br /> u,c rtil Sl 22 5e <br /> Total S )>� <br />