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12/08/1999 10:41 _4089421499 I PAGE 02 <br /> NON-HAZARDOUS SPECIAL WASTE ASBESTOS M <br /> � ANfFEST •. " �� <br /> N waste to a*beftoe Waste,pOmpfete Socdons L U.111 and tv. <br /> !f wafts la nQr faboal*offs,CompleM only$et.'tlonf L 11 and M. No. 509650. <br /> a. G}eneretOt Name: <br /> b.Generatlhg LDC&tion: <br /> c. Address <br /> f. Phone No.: <br /> If owner of the Qfnfratl fecll f. Phone No.; . <br /> r19 @Y dHlora from f}ta eeftfretor,provlde: <br /> Q.,OwneKa Name: ' y <br /> +or's lihone lYo'I1!' . <br /> 1 <br /> I. BRI WASTE CODEQ / I� <br /> z COrltelnws DM-METAL DRUM <br /> J. QsDP•PLASTIC DRUM <br /> Dolof waste: .4 <br /> k. Oluarl a -SAG <br /> U� E -d MR.rWRAP PLASTIC BAG <br /> T TRUCK wRAp <br /> GENEIOA70R'9 C£RTItICATION: i O -OTHER <br /> arty e00ecabte wim law,hat b na.ebY co"that its above named maiww ti not a haxardOUa v.aaja a dellnfO oy ap CFR Pbt lei W IT <br /> e00eoabne MQUlMIl AND,If Mf we* la&la ad��•dMAW and Packaged.And Is in Preow eendltlon fa naryP�+tlon soaordU'� <br /> treaa+wne reakvf M a prfvloU doee wata au now P - <br /> r+esakso^a I col and wwra„t fief vw wants hu been trail Inrfaklaled hem qOd to the Land OhPoaal Y -YARDS POUNDS <br /> haurdoua WNW as darted fry 40 CFR hrt 261. 1remeft of M CPR Part tet and W no kW a h7t -CUBIC METERS <br /> r <br /> �wo <br /> - Y' •CUBIC YARDS <br /> o -OTHER <br /> Gwnfretpr Ao w <br /> ~ ehomentDow <br /> TRANSPORTEAI <br /> L Name: <br /> TRANSPORTER II <br /> T h. Name <br /> b.Address; <br /> I. Addra*s: <br /> c. Driver Nam67fitle az A <br /> wvvrYra 1. Driver Name/Tltte: <br /> d. Phone No.: - - f. Truck No.:II II '' PRatryn rE <br /> /-r--i�� k Phone No.: I. Truck No.: <br /> �f. VahtdO License No./Staff: <br /> P,,ACknowledgentertt I Receipt of Materfala, m.vehieff Ucense No./State: <br /> ACknowledgernent of Receipt of Matwlals. <br /> Odver 1 <br /> A. $ita �Naynf o. Phone No.: <br /> b. Physical Address X00/ IIA/t'O iQd.! d. Malflng Address <br /> rv6�Z�ldrrQF Cq <br /> a. Discrepancy IndlonUon Spm: <br /> I hereby ce"VW the above named Mel hes been Olocal the best of <br /> My lio <br /> awfodpa the forsgol (a <br /> rf�p n9 true and aCOUBtf. <br /> a. Shfppera's'Name: <br /> b. Shlppetrsa*Phone No.: <br /> C. Shipper&'*•Address; <br /> d. Shlppera's SPeclal Handling InatruOtlpne and eddltlonal Informal <br /> CEATIFICATIONT I hereby deogn that rtes cogtenfy pt this conalgnrpanl ue fully and aeeuratety d.acrlbad eboJa b r <br /> mtrked,&rid labslVd/plgcafded,and Ms in'eb ris0acla hyOraDlr COhdltlgn ter tran�porr a000rding to applk ebl�Inprnps0nel and eatlonal And aro Oftaalsad,A <br /> iilPO ng name eckagad <br /> , <br /> governmental reguleffdne. <br /> f. ShIPPON'S*Noma&Title: . <br /> • mwrros <br /> f. Nafhe and Address snroP«..5ry aa,e -L-�- <br /> ResfOonsible Agency <br /> Rrtable; Q Nori-enable: ❑ Both %h sfOfe <br /> %^onfrlaole <br /> 9hl <br /> I i bra w e'a OpmPany WMCh owns.Nispy,OGeratK.OOrkrab,Or auPe vtm VI fulUly being dMrtplbhed or renovated.Or the damdniOn or renovation opwatll or both. <br /> !WORb t ONEY 7Hg0001H OR/STANDARD REGISTER CONTRACT_ , /� <br /> RETURN TO OPERATOlj tT/'�porQrs+t+d <br />