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12:08i 1399 10:al ---a0^o9a21a99 T , PAGE 02 <br /> l NON-HAZARDOUS SPECIAL WASTEASBESTOS MA <br /> 1 NIFEST <br /> n w"te h a11bostos W1181e,Oomplets Sections L 11.111 and IV. <br /> If waste lo J�r..beetP3*-W'con"plets only Sections L II andW. No. 509650. <br /> A- Generator Name: 45.57—' <br /> b.Generatlhe Location: <br /> c. Address '� � �^F-C ---- <br /> ^ ►Q /.a.tZ� d.Address; <br /> e. Phone No.: <br /> If Owner Of theI. Phone No.: <br /> gvnsntlnQ facility dtffon from the generator.provlds• <br /> Q.Owne(s Nsmip t 1 { <br /> �wners)+honeIVo.' k 1 1 <br /> 1. 1311 WASTE CODE M / P <br /> 2 Containers LI <br /> Mt:fA1 OF <br /> PLASTIC DRUM <br /> _IS <br /> M'L <br /> J. IJeacAptlon of Waste:_dLy _k O SAG <br /> tl� 71 FP 0 <br /> TYPE SA-0 MIL LA6TIC SAG <br /> Or <br /> WRAP <br /> GEN07ATORe CERTIFICATION; l hereby puny Oat P+a above named matanr N not a <br /> a^y fooncabM t"as is..no$"tin peperrr dMrf'bad.destAted en0 �ardow wafts as defined by 40 CFF part 2st or jJj�lTg <br /> *="Cable wgulaeoru;AND,If the water Is a heteratar raid.M a Packaged. <br /> d In in pmr condition fov trwwpoAafon awordlnp to P -f'OUND9 <br /> Ztsa"ona,l OWW and warrant seat taw week Ms been treated in sa�leted huyrdow*1119110 the t.ard DApogl Y -YARDS <br /> rkt:ardvus waste N daNwd by ao CFR Part 261, lremanea o1 ao CFA Pan 2011 and to no longer a 5 -CUBIC METERS <br /> r' _ <br /> t 41/ t 1 ri Y' •CUSIC YARDS <br /> Ovrnratd ,erg py <br /> O -OTHER <br /> shtoment[)ass <br /> t <br /> TRANSPORTERI <br /> L Name; <br /> TRANSPORTER II <br /> T h. Name: <br /> b.Address• <br /> f• Addreq: <br /> C. Onver Nsm11/flde: <br /> vrun►t: J. Driver Narne/71tie. <br /> d. Phor,s No.:�=- .Z—�"�a.Truck No.: <br /> --E►-•F.+ �� k Plwrte No.: I. Truck No.: <br /> �J. vshtde Uc.nse No./9tate. <br /> rr,Acknowladgemertt of Receipt of Matertalo. m.vehlol11 Li ense No./State: <br /> u Acknowledgement of Receipt of Materials. <br /> DA n, ;. <br /> tlA.r nsare t <br /> a..Sita Name: <br /> C. Phone No.: <br /> b. Phyakal Addre (+rOoi -• <br /> /1�0 t iA�C O Rd d. Melling Addhias — <br /> 1�y6R/J�1QrQF C,q <br /> s, DISLTepancy Indloatlon Spam: ` <br /> I hereby certify III fie aI named M41I has been accepted the beat Of <br /> r f knowrsdDa the foreyOlnp is true and accurate. <br /> Mena orAuhwtae,apNlt �� , � • ' t'� /1 •. •.ia <br /> Mawr Dere <br /> a. Shfppors9'Name: <br /> b. Shtppers's'Phone No.: <br /> C. Shrppva'11'Address: <br /> d. Shlppera'S Special MwWlln9 Instryctjons and additional Information: <br /> deglare <br /> MEATI,and l boll 1 hereby d,and that tda cogtana I!' 'I conalyn�enl ate fuly and aet urataly dacdbed eboVe by proper shipping name and are of11faHfed,packaged, •' <br /> mirkad,and labtltld/pl{tardsd,and 11r►in aJl r411o11cta M'Pro"fir r,Pndl110n ter lrart�port svoording to epplkebh Intorna0ons1 and national governmental regulations. <br /> 0. Ehlppgh'S-Name 6 TRI.:. <br /> !^^�Trti Sn PPRa�prera <br /> t. Natlts and Address •�--•e---�-� •'•• <br /> Responsible AQency: <br /> U'FAatSIe: Non-Irlabro. ❑ Both <br /> x fiabla x nonfrlable <br /> ' 9hlPPw-Nm to the . <br /> 6PR7pany wfdch owns•Nafq,PPwaaa C"rdrols,or wpwvfm sero radIlly being do i Ished or renovated.or era demolition or renovation opwana,.or both. <br /> !�ORb�IOFtEy?1WODertBFl/eTAN[UitpREptf3fERCONTMCT- <br /> RETURN TO OPERAI �• <br />