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;1VNON-HAZARD OUSS�EMAL 'WASTE & ASBESTOS MANIFEST <br /> Ifwaste I5 asbestos waste,complete Sections 1 If III and IVNo. 041908 <br /> If wasteis�Zlasbestos waste,complete only Sections I II and III <br /> GENERATOR (Generator completes allot Section t) <br /> ; , <br /> b Generating Location �`' f <br /> -, <br /> Generator Name �� 'f � �� <br /> rte' <br /> >>�rrfi i%r.,�" ,�•,�•,,r ', d Address <br /> Address i s <br /> r '1 <br /> f Phone No <br /> Phone No <br />>wner of the generating facility differs from the generator,provide <br /> Owner s Name In Owner s Phone No TYPE <br /> Containers DM "ETAL DRUM <br /> DP -PLASTIC DRUM <br /> BFI WASTE CODE �( S I t I tB -BAG� ' i - k Quandt Units No TYPE -6 MlLPLASTIC or WRAPBAG <br /> Descript+on of Waste r n -TRUCK <br /> -OTHER <br /> 40 CFR Part 261 or UMITS <br /> GENERATORS CERTIFICATION I hereby certify that the above named mater and s inproperEsc oaddi+ doefied transportation according to P -POUNDS <br /> any applicable state taw has been properly described classified and packaged <br /> p 9 <br /> applicable regulations AND,if the waste is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Y YARD <br /> Restrictions I certify and warrant that the waste has been treated in aC`cordance with the requ�re+'nents of 40 CFR Part 268 and is no longer a _CUBIC <br /> C YARD, <br /> hazardous waste as defined by 40 CFR Part 261 i// �' �� i O -OTHER <br /> Shipment Date <br /> Generator Authonzed Agant Name Signa re <br /> Transporter I complete e-93eCtfon II T9► SPORTER Generator complete a-d, T iter II coin late h-n <br /> TRANSPORTER II <br /> TRANSPORTER / , <br /> h Name <br /> i <br /> Address <br /> Address <br /> f <br /> '1l,l i Driver Namefritle pmiNTlrYPE <br /> c Driver Namelritle PRItJTlTYPE <br /> 7" `' ' k Phone No 1 Truck No �..� <br /> d Phone No a Truck No �- <br /> Y y •, -x" m Vehicle License No/State <br /> f Vehicle License No/State Acknowledgement of Receipt of Materials <br /> Acknowledgement of Receipt of Materials [1= n sn nt Dale <br /> Driver S nature <br /> Shi merit Daie <br /> g Drover 5 nature <br /> DESTINATION (Generator Completes aA destutatlon site completes e-t) <br /> Sectron <br /> c Phone No <br /> a Site Name <br /> d Matting Address <br /> b Physical Address <br /> e Discrepancy Indication Space <br /> pled and to the best of my knowledge the foregoing is true and accurate <br /> I hereby certify that the above named material has been acce <br /> f ' Receipt Date <br /> Name of Authonzed Agent signature <br /> Ott ASBESTOS (Genemtor complete a-d,f,g,operator"completes e) <br /> b Operator's'Phone No <br /> a Aerator's"Name <br /> c Operator's"Address <br /> d Special Handling Instructions and additional information <br /> nt are hcable International and government regulations <br /> OPERATOR'S CERTIFICATIONthereby declare that the c condition this consignm <br /> by highway laccord+ng io app ly and accurately described above by proper shipping name and are classi <br /> packed,marked,and labeled,and are to alt respects in grope <br />