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��v�r`nry�.MnVVV� Olrc%olN�L.YYM.7I C do AStMS 1 VS MANIFEST <br /> 6a - r <br /> If waste is asbestos waste,complete Sections 1, 11, 111 and IV NO- 780951 <br /> If waste is NOT asbestos waste complete only Sections I«ff and III <br /> lection IGENERATOR Getreratar <br /> t �< f =mplews s!i of 5ei:tlort t} 4,- <br /> i � r <br /> rator Name «✓��ZG7N b Generating Location Cki/'C' r't/ SI-6* 9--y if <br /> Address d Address 7?-2 s L) <br /> Phone No f Phone No <br /> owner of the generating facility differs from the generator provide <br /> Owner's Name h Owner s Phone No <br /> TYPE <br /> BFI WASTE CODE C / I s ` J Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> B +BAG <br /> Description of Waste s�i� - f,�i rtl3/D,20 C d/L/,r k Quantit Una$ No+ TYPE BA -6 MIL PLASTIC BAG <br /> T TRUCK <br /> O - r WRAP OTHER <br /> GENERATOR S CERTIFICATION i hereby cadrfy that the above named matenal is not a hazardous waste as defined by 40 CFA Part 261 UNITS <br /> or 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,If the waste Is a treatment residue of a previously restricted hazardous waste subject to the land Disposal Y -YARDS <br /> Restrictions,I certify and warrant that the waste has been treated in accordance with the requirements of 40 CFR Part 268 and is no longer M3-CUBIC METERS <br /> B hazardous waste as defined by 40 CFR Part 2661 4=0 W— C:ffJF7i//0/4,/ 4-a Y3 -CUBIC YARDS <br /> O -OTHER <br /> 1 1 1f Lo I g s <br /> Generator Authorized Agent Name Signature ! Shipment Date <br />-ctlon 19 = TRANSPORTERTransporter I oorripletea g-ll a'a . b <br /> •Generator complete a-d,•'Transporter <br /> F Y <br /> TRANSPORTER I TRANSPORTER II <br /> Name - / <br /> h Name <br /> s I Address <br /> Driver Name/Title l A j Driver Name/Title <br /> 1! INT!TYPE PRINT! <br /> rePE <br /> Pho e N e Truck No k Phone No <br /> I Truck No <br /> dehicle License No /State 2 m Vehicle License No /State <br /> Acknowledgement of Receipt of Materials _ Acknowledgement of Receipt of Materials <br /> No 8613142 <br /> fl y1,r BROWNING-FERRIS INDUSTRIES <br /> " T13 i� wl Tiog gat. Sc` i7 4 <br /> 14,W7 ;t_=q4 l '-Ids _,- , aW`— <br /> l ll_ 11`C=+`�iy .1Jr '-.P-r'Du�i S -COP-11 <br /> 4 ■Yi11kI <br />-a'r,• j Lreretor RESER. M <br /> 32, V y� ,r�'a:f-, Ira # f ;i�.31Q �!¢: #: <br /> 755 Wtcare Wt Net k: tR <br /> Cr Act ij1, 311; cty f.L'r,.; Eitenda.' <br /> -_..._.—-----------C---..____ <br /> l� 1.15A <br /> iY <br /> 5,to IOSeli. ; is So <br /> E ?2 59 <br /> 'ot?1 3 125 0@ <br />