Laserfiche WebLink
Apr 26 16 02:10a Kinder Morga0n Ino.lp1g 17145606579 p.1 <br /> - C "RAC 'Qi'OLIC NON-HAZARDOUS SPECIAL WASTE & ASBESTOS MANIFEST <br /> 'SERVICES <br /> , _Q� If waste Is a rbasics wade,comolete S@cltens t,Il;III and IV <br /> ,a.v .� J If waste fs N OT asbestos tvasle,complete Sections I.II and I:I <br /> I. GENERATOR (Generator complett s la-r) <br /> I a.Generators US PAI . um rr b.Manifest Dowma t Num ar c_Page '1 of <br /> II- c�,arS 'n�'.tlao -.. ... _ _ r $�a�oaz: ----_a. -• -- <br /> tl.ocher _. a.cenefate I f s• <br /> kl��4t�'4`?�td1F�a�r•. <br /> avN'Qf+ .. - •Y:, .. x.: .. ;1prawr..&„gxon �y.Rp' f ... <br /> °� .� ,:: .: ,.:. yi _''3lrerdr'6 Cn.92-8513; <kaa- :moi' .. t , '.�il'ri#560-4&T7: . <br /> I Stv #1 );58pxA88.7::; _. <br /> If ownar of the goneradr•g facility,differs from the genas,tor,pmvida: 1 <br /> h.Owners Name: I.Owners Phone No.: <br /> j.Waste Profile# — k.Exp.Date J.Waste Shipping Name and m.Containers it.Total o.Unit <br /> Description N'o. Type Quantity _—_ %WVul <br /> 421?166fA34 „ q/812 n 7+ , :.: :. Sail W1 CM Y <br /> I <br /> GENERATOR'S CERTIFICATION: I hereby certify that the above named matenal is not a hazardouswaste as defined by 40 CFR 261 or any applicable <br /> =_tai.law,has been properly described,classified and p ackaged,and is is proper condition for transportation according to applicable regulations;AND,if tills <br /> waste U treatment resid to or a previously restricted h¢ardour waste subject to the Land Disposal Restrictions.I certify and warrant that the waste nae <br /> _b elvtre. ed In of oro _ :the requirements of 40 CFRRf 268 and is�no{longer a hazardous waste as defined by 40 CFR 261. — <br /> _ .�1' .Yi- �•-�-v,-.- rK ok[c-rr.! ���+tr.rr:-ra +-'t �— _ <br /> .Ge rater Authorize ant Nanae(Pdnn�— q.Signature ____— r.Data <br /> IL TRANSPORTER l (Generator comp etes Ila-b and Transporter completes Ilc-e) <br /> ra.Transpq�&�Wi�lWAtUprrt'�iWkTALSC-BVICK B IC. ._ <br /> l,a 450 E;2nd Street. <br /> Benicia;CA'9R83 t7 ,. (7(III)748-7775 l <br /> ub.Phone:__ - <br /> Q_ Zb ' '--- - <br /> �a Fiv rName Print —_..---_— — d.i care__....—_ e D <br /> ill. DESTINAMON (Generator comptet: Illa-c and Destination Site completes Ilid-y) <br /> ' a.D �t F-'��[` i �g vP dcecers: c.US EPA Number d.Discrepancy Indication Space: <br /> �Fi 147 CJ�l,RLL <br /> I 541 Bailey led <br /> PEMbtllr&CA S4565 WJA <br /> hero certify that the above named_materlalhas beer accepted and to ate oest of my knawle a the fore om is true and accurate ' <br /> —=Y -— <br /> =Na!re of AuthorizedA enl Print f.S anature — .Date — <br /> I _9—s-1._.-- <br /> IV. ASBESTOS (Generator completes Va-f and Operator complete Ng-i) <br /> s.Operator's td:aina and Address: ::.Responsible Agency Narna and Address: � V <br /> b.Phone: <br /> a.Spacial HenUliny Inslrur.[ions and Addilio�at NNornlat dn: _------ ------_-���— ---_—.---- <br /> F.EJ Friable ❑ limon-Friable G Both _;Friable %Non-Friable <br /> t OPERATOR'S CER'7FICA1 ION:I hereby declare that i ie contents of this oonsignicent are fully and accurately described above by the propor shipping namai <br /> and are classified,packaged,marked and Iabeled;placa dad,and arum all respects in proper condition for lmrspon according to applicable iatanraliona and I <br /> national govefnmantal regulations. _ ___ _ _ __ _ _______ _ _ <br /> q.Operates Name and title 'Print) .� _ h.E,cmiture I.Data _ - <br /> -,Operator refers to the company which owns,leas hales,enmiois,or supervisors the faciilty tieing derrhollshed or renovated,pr the tlemolitlon or <br />