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W NON-HAZARDOUS SIIECIAL WASTE & ASBESTOS MANIFEST <br /> t <br /> If waste is asbestos waste,complete Sections 1 Il,iii and IV No. 041906 <br /> If waste is NOT asbestos waste,complete only Sections 1 11 and III <br /> A <br /> S GENERATOR (Generator completes all of Section I) <br /> b Generating Location <br /> a Geflerator Name <br /> d Address - -' <br /> c Address <br /> f Phone No <br /> e Phone No <br /> It owner of the generating facility differs from the generator,provide <br /> g Owner's Name h Owners Phone No <br /> TYPE <br /> 'i Containers DM-METAL DRUM <br /> i BFI WASTE CODE DP PLASTIC DRUM <br /> B -BAG <br /> ' 1 k QuantityUnits No TYPE BA -6 MIL <br /> oPLASTWRABAG <br /> 1 Description of Waste <br /> [1T TRUCK <br /> O -OTHER <br /> GENERATOR S CERTIFICATION I hereby certify that the above named matenal is not a hazardous waste as defined by 40 CFR Part 261 or <br /> UN iT5 <br /> any applicable state law has been property descnbed classified and packaged and is in proper condition for transportation according to P -POUNDS <br /> ment residue of a previously restricted hazardous waste subject to the Land Disposal Y -YARD <br /> applicable regulations AND,if the waste is a treatS <br /> Restrictions t certify and warrant that the waste has been treated iii accordance with the requirements of AO CFR Part 268 and+s no forager a y' _CUBIC <br /> YARDS <br /> S <br /> hazardous waste as defined by 44 CFR Part 261 / / O -OTHER <br /> Shipment Date <br /> Generator Authorized Agent Name SignatuFe <br /> Transporter f complete <br /> Sectlof�II T UNSPORTER G a7--Transporter <br /> complete a-d, Tran iter u late h n <br /> TRANSPORTER I TRANSPORTER Ii <br /> ame + ,� In Name <br /> b Address Address <br /> r•" f, �^ I Driver Name/Title PRINTlr1'PE Y✓ <br /> c Driver NamelT+tle PRINTlTYPE <br /> d Phone No <br /> e Truck No k Phone No Truck No <br /> i <br /> f Vehicle License No/State m Vehicle License No/State <br /> Acknowledgement of Receipt of Matenals Acknowledgement of Receipt of Materials <br /> C <br /> r n Sh rat E= <br /> Date <br /> g Sh t Date Driver Stgnature <br /> purer Si tura <br /> Section III DESTINATION {Generator completes a-d destination site completes a-f) <br /> c Phone No <br /> a Site Name <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 /> f Receipt Date <br /> Name of Authorized Agent Signature /` <br /> IOfi IV ASBESTOS (Generator complete a-d,f g,Operator'completes e) <br /> "Operator's'Name b Operator's'Phone No <br /> c Operators`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 delsenntedrnabionabandroper govemmshipping name d are clan <br /> t egulat+0na <br /> packed marked and labeled,and are in all respects in proper condition for transport by highway according to app <br />