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i NON-HAZARDOUS SPEAMAL-WASTE & ASBESTOS MANIFEST <br /> If waste is asbestos waste,complete Sections I II III and TV {'►(� �]c <br /> e If waste is NQT No.asbestos waste,complete only Sections 1 11 and III /�i 0[J J 6 <br /> StactTon I GENERATOR (Generator completes all of Section f) <br /> a Generator Name `1 1"PW, S`L` R '' '' b Generating Location <br /> c Address d Address -� s�s] i t , t:f I C LT. Lr 0.3S S!:CL!-. t' Yi01- <br /> OC1rTQ" L./ <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 BFT WASTE CODE ( r 4 'J 1 1 5 r () j ti Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> B BAG <br /> I Description of Waste k uantity Units No TYPE BA 6 MIL PLASTIC BAG <br /> or m mT TRUCK <br /> O - WRAP <br /> OTHER <br /> GENERATOR S CERTIFICATION I 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,if 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 treatedin accordance wit .the requirements of 40 CFR Part 268 and is no longer a M3 -CUBIC METERS <br /> hazardous waste as defined by 40 CFA Part 261 / Y -CUBIC YARDS <br /> O -OTHER <br /> Generator Authorized Agent Name Si Lure , Shipment Date <br /> Transporter I complete e g <br /> Section II TRANSPORTER (Generator complete a-d T rte,11 corn lete h-n <br /> 0 TRANSPORTER I TRANSPORTER II <br /> a Name AI LI,ASTL TRANSPCIRTATIOt� h Name <br /> to Address 12475 LLAGaS AVEALE I Address <br /> gAi,' KART—N, CA <br /> c Driver Name/Title H Driver Name/Title <br /> PRINTItYPE pRfNTfrYPE <br /> d Phone No a Truck No G����' k Phone No I Truck No <br /> f Vehicle License No/State r' �� m Vehicle License No/State <br /> Acknowledgement of Recel t of Materials Acknowledgement of Receipt of Materials <br /> 4�� '� 1� � <br /> g !! ! n <br /> Drrijr S nature shipment Date Driver Signature Shie=nt Date <br /> Section III DESTINATION (Generator completes a-d destination site completes e-4) <br /> a Site Name ' i 1 ASCt� ' c Phone No <br /> b Physical Address d Mailing Address <br /> e Discrepancy Indication Space <br /> 1 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 <br /> Name of Authorized Agent Signature Receipt Date <br /> S IV ASBESTOS ;Generator complete a-d,f,g,Operator"completes e) <br /> a Operator'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 classifte <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 />