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i <br /> NON-HAZARDOUS SPECIAL .,WASTE & ASBESTOS MANIFEST <br />� CC <br /> If waste is asbestos waste, complete Sections I, II, Ill and IV No. 7 8 O 9 J 2 <br /> If waste is NOT asbestos waste, complete only Sections roll and III <br /> ct .rx - _ �' GENERATOR <br /> 3 ator Name 2� �1G_,t _ Ui4 b Generating Location _ <br /> kddress ��� IBJ Y' d Address 3�775— 777—agVC / Lw`� <br /> � ff <br />'hone No sh�i �� — d��S f Phone No , <br /> vner of the generating facility differs from the generator provide <br />)wner's Name h Owner's Phone No <br /> TYPE <br /> IFI WASTE CODE / DM-METAL DRUM <br /> l ! Z Containers DP -PLASTIC DRUM <br /> 8 a BAG <br />)escnption of Waste Tv JL - Lw, ' Yp/'o -AY,)✓vJ k Ouanth - unds No TYPE BA -S MIL PLASTIC BAG <br /> or WRAP <br /> / a d Ef O -OTHER <br /> ENERATOR'S CERTIFICATION t hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Part 261 UNITS <br />'any applicable state law has been property described,classified and packaged,and is in proper condition for transportation according to P -POUNDS <br /> ppticable regulations,AND,If the waste is a treatment residue of a primlousty restricted hazardous waste subject to the Land Disposal Y -YARDS <br /> estnctions I certify and warrant that the waste has been treated In aawdance with the requirements of 40 CFR Part 268 and Is no longer M3-CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261 C_-yky6-VrZ,0^1 Y3 -CUBIC YARDS <br /> 1,ll' /�' /:` --�.f l [El C7 9131 <br /> O -OTHER <br /> enerator Authorized Agent Name Signature Shipment Date <br /> lion H TRANSPORTER Gen:irstor a a-d' Transporter 1 oo:np'to_hQ <br /> COrttpiet , Trarr9porter IT C6mplete h-n <br /> TRANSPORTERI TRANSPORTERII <br /> lame 'p 4k Cir h Name <br /> i Address ^ <br /> river Name/Title O Ji I Driver Name/Title <br /> PRI T PE PRINTJTYPE <br /> hone No 's_ 9 P. 4�2 0 a Truck No ; It Phone No I Truck No <br /> ehicle License No l5t - m Vehicle License No /State <br /> i <br /> cknowli dgement of Receipt of Materials/ Acknowledgement of Receipt of Materials <br /> I <br /> NO 8613130 <br /> BROWNING-FERRIS INDUSTRIES <br /> TIl2 I-� 1- 'Z6 -7 Til- Ou-. �2 {b :7 <br />�7: '�a4+ CMS 4 1545111A, Ma tJEI�� c' Lit +Sri -tair 'a- i,a, <br /> r iIDr' - <br />'- ? - , t+ltivy <br /> i wG*r� rl�RdTv <br /> a2nt 4tt,a.Dr R10BEIf 4 <br /> iac3i,� @ N yd Scz4e I-i r *ale fkit <br /> S5 wt Tare lit; i 'Net; wt.,, to r <br />�r hCtildl a1_i +fit; <br /> ; _—_i4- t' Tis1433 <br /> 50 <br /> Svr, Total s K,.50 <br /> TIE &,PDO& 22.550 <br /> 10ta1 <br />