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r NON-HAZARDOUS SPECIASTE & ASBESTOS MANIFEST <br /> i t <br /> If wpste q asbestos waste,complete Sections I,It III and IV No. 036399 <br /> If waste is NOT asbestos waste,complete only Sections I,it and III <br /> S Oil Y ,GENERATOR (Generator completes all of section t} <br /> a Generator Name - r�` l� GC _ b Generating Location <br /> c Address �I . . l d Address <br /> / <br /> - <br /> e Phone No - f Phone No <br /> If owner of the generating facility differs from the generator provide <br /> g Owner's Name - h Owner's Phone No <br /> TYPE i <br /> I BFI WASTE CODE -I Tfl F1 r' Containers DM-METAL DRUM <br /> I I DP -PLASTIC DRUM <br /> B -BAG <br /> I Description of Waste k Quanti units No TYPE BA -6 MIL aPLA C BAG <br /> P <br /> H I I Um m T -TRUCK <br /> O -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,it the waste is a treatment residue of a previously restncted hazardous waste subject to the land Disposal Y -YARDS <br /> Restriction I certify and warrant that the waste has been treated in accordance with the requirements of 40 CFR Part 268 and is no longer a M3 -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261 Y3 -CUBIC YARDS <br /> O -OTHER <br /> Generator Authonzed Agent Name Signature Shipment Date <br /> le <br /> Section U TAAN$POATER {Generatorooinptetea-d xranm"sp°nerii �t tte� ) 1�4 <br /> TRANSPORTER I TRANSPORTER H <br /> a Name � <br /> C /'J h Name <br /> b Address ' + ' ` t r� f -r i r Address <br /> f9,3c41� <br /> c Driver Namelfitle Driver NamelTitle <br /> PRINTlrYPE <br /> PRINTrFYPE 9 t fI Truck No <br /> d Phone No <br /> e Truck No k Phone No <br /> i <br /> I Vehicle License No/State ' i m Vehicle License NoJSt'ate <br /> Acknowledgement of Receipt of Materials Acknowledge <br /> ment of Receipt of Materials <br /> n <br /> gSh nt Date <br /> Driver tore Shi nt Date Drner signature <br /> Section III DESTINATION (Generator completes a-d destination site completes e4) <br /> a Site Name c Phone No <br /> b Physical Address d Mailing Address <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 Name of Authonzed Agent Signature / Receipt Date <br /> I n iv ASBESTOS (Generator complete a-d,€i 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 1 hereby declare that the contents of this consignment are filly and accurately descnbed above by proper shipping name and are classif <br /> packed,marked and labeled and are in all respects in proper condition for transport by highway according to applicable international and govemment regulations <br />