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NON-NAZARD`.US SPECIAL WASTE& �--SBESTOS MANIFEST <br /> If waste Is asbestos waste,complete Sections I,IL m and IV t` Ar O. 7 <br /> If waste is NU asbestos waste,complete only Sections I,II and ID fel <br /> Generator Name L�ytll'i�Y ] 7D 8'1� # �,0 <br /> b Generating Location <br /> c Address ]P� �� <br /> FMM, M 90622-5077 d Address 1711 Z. YosEmM <br /> MUMMM, CR <br /> e Phone No 2 �-137 1 �' �$ N/A <br /> If owner of the generating facility drffers from the generator,provide f Phone No <br /> Owner's Name p5 GAMY cs <br /> h Owner's Phone Na <br /> nift <br /> BFI WASTE CODE c 4 3 5 fi7 $ 1 2 g 7TT--m <br /> TYPE <br /> Containers DM-METAL DRUM <br /> fjf3Qty DP -PLASTIC DRUM <br /> Description of Waste B -SAG <br /> k Quante t Units No TYPE BA -6 MIL PLASTIC BAG <br /> D D D p I m or WRAP <br /> T -TRUCK <br /> GENERATOR's CERTIFICATION l here ce O -OTHER <br /> by rtdy that the aboy -na(ned material is pot a hazardous waste as defined by 40 CFR Part 261 or UNITS <br /> any <br /> applicable state law, has been property desvibed,,d9sified and packaged r and is in proper condition for transportation according to P -POUNDS <br /> ' regulations,AND,If the waste Is a treatment residue of a previousty restricted hazardous waste subject to the land Disposal Y -YARDS <br /> Restrictions I certify and warrant that the waste has been aeat�d in <br /> hazardous waste as defined by 40 CFR Pan 261 a LI7� mate�`d'tnR re wr menu of 4o FR Part 266 and is no longer a M' -CUBIC METERS <br /> _ �'3 OGiI1�At9Y a <br /> PATRIM D�RD/ DILLARD EW, �,-� �' Y -CUBIC YARDS <br /> �' O -OTHER <br /> Generator Authorized Agent Name Signature <br /> Shipment Date <br /> �`RA,1VSP-ORTER k_enerateronm lets a-d, TranaporbarI complete e� <br /> P Trans er TI coni late hat <br /> T�1�ANSPORT�E�I Q <br /> bame / <br /> h Name TRANSPORTER <br /> b Address <br /> i Address <br /> Dimer Name/ ice <br /> i �yPE l Driver Name/Tnie <br /> Phone No a Truck NoPFUhrAWE <br /> k Phone No i Truck No <br /> Vehicle License No./State m Vehicle License No/State <br /> Acknowledgement of Receipt of Materials Acknowledgement of Receipt of Matenals <br /> n <br /> r""W�SNPnont nate driver s name <br /> sr>a Difte <br /> Ih <br /> k F� <br /> Vtt,e if <br /> d ,3 ; <br /> c Ph e,NR <br /> t Physical Address � , <br /> • .D <br />' d Mailing Address V <br /> 50 <br /> i Discrepancy Indication Space <br /> hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and a 'A' 100 1/107 <br /> dAuihortredApent s�nauna POO 09--313" <br /> R..0=0,. <br /> fO <br /> pperses*Name <br /> rhiPP8rs%*Addressb Shippers's*Phone No <br /> Address <br /> Shippers Special Handling instructions and additional information <br /> IFICATIOfI I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified. packaged <br /> d,and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations <br />