Laserfiche WebLink
NON-HAZARDOUS SPEC1ALWASTE & ASBESTOS MANIFEST <br /> I If waste is asbestos waste,complete Sections I II,III and IV 1�1 f1 /� <br /> If waste is NOT asbestos waste complete only Sections I II NO. 0 and III 4 <br /> tion I GENERATOR (Generator completes all of Section]) <br /> a Generator Name Ci_T ZVR01, SA,N fir;"f' b Generating Location CLf.VR0,, <br /> c Address d Address 905 liI__hjAMh. ho sl (_-(tic` _' TREi_f ''moi <br /> SIUC KTO'\, CA <br /> e Phone No t Phone No <br /> If owner of the generating facility differs from the generator provide <br /> g Owners Name h Owner s Phone No <br /> TYPE <br /> i BFI WASTE CODE j _ 141 Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> B -BAG <br /> j Description of Waste k Quantity tints No TYPE BA -6 MIL PLASTIC BA <br /> or <br /> a m T -TRUCK <br /> O -OTHER WRAP <br /> GENERATORS CERTIFICATION 1 hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Part 261 or UNITS <br /> any applicable state law has been properly described classified and packaged and is in proper condition for transportation according to P -POUNDS <br /> applicable regulations AND,It the waste is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Y -YARDS <br /> Restrictions I certify and warrant that the waste has been treater#in accordance with the reguifements of 40 CFA Part 268 and is no longer a M3 -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Pari 261 Y3 CUIBIC YARDS <br /> 1 rf1 y{ /I / ( O -OTHER <br /> 1✓�`�— i'I lr il f I i�w lid I <br /> Generator Authorized Agent Name Signature Shipment Date <br /> Section IT TRANSPORTER (Generator complete a-dT <br /> Trn iter IIGompjlete h n <br /> TRANSPORfERI TRANSPORTERII <br /> aOame ALDWASTE TRAM-TOR T ION' h Name <br /> IL475 LLAGAS AVENUE <br /> b Address i Address <br /> SAN MARTIN, CA <br /> c Driver Name/Title 10"I"`41)",7Z__1P I Driver Name/Title <br /> 6' PRINTT(PE �f C PRINT/TYPE <br /> d Phone No a Truck No G k Phone No I Truck No <br /> C 5 m Vehicle License No/State <br /> f Vehicle License No JState > ~ <br /> Acknowledgement of Receipt of Materials AcknowWgement of Receipt of Materials <br /> g n <br /> Darer Si nature Sh nt Date Driver Si nature Shipment Date <br /> Section III DESTINATION (Generator completes a-d destination site completes e t) <br /> a Site Name BEI VASCO 'b' c Phone No <br /> b Physical Address 4U0I N. VLSi,U -,0AD d Mailing Address <br /> L1 VL'tfU'x F, ( t, <br /> e Discrepancy 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 /> i <br /> f ' <br /> Name of Authorized Agent Signature Receipt Date <br /> AMktinn N ASBESTOS (Generator complete a-d f,g,operator"completes ell <br /> a perator's'Name b Operator's"Phone No <br /> c Operator's'Address <br /> d Special Handling Instructions and additional information <br /> OPERATOR'S CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are class <br /> packed,marked and labeled,and are in all respects in proper condition for transport by highway according to applicable international and government regulations <br />