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ia <br /> NON-HAZARDOUS SPECIAL WASTE & ASBESTOS MANIFEST <br /> -. <br /> If waste is asbestos waste complete Sections I, Ii, iii and IV NO. 780948 <br /> t If waste is NOT asbestos waste, complete only Sections I, If and III <br /> 1 ✓'7+ r * _ <br /> GENERATOR (Generatoraixitpletea�all of Sect[on ry'=-��`4"•�`4�-�s.•r -: �'>'" =n'�x�.�"-'- <br /> 3enerator Name _ b Generating Location <br /> kddress y'� 7 a d Address _�'�7 <br /> _1 Cf' <br />'hone No r Z ^S f Phone No /✓_ _ <br />+mer of the generating facility differs from the generator, provide <br />]wner's Name h Owner's Phone No <br /> TYPE <br /> 3Fi WASTE CODEGAA ? DM-METAL DRUM Containers DP -PLASTIC DRUM <br /> B -BAG <br />)escription of Waste .c'/� / '`%G/�' C,f, /sem, ✓� k CIn 4, Urns No TYPE BA -6 MILoLASTIC PBAG <br /> WRAP <br /> J L7 1 T TRUCK <br /> O -OTHER <br /> iENERATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Part 261 UNITS <br /> r any applicable state law has been property described,classified and packaged,and is in proper condition for transportation acoording to P -POUNDS <br /> pplicable regulations,AND,If the waste Is a treatment residue at a previously restricted hazardous waste subject to the band Disposal Y -YARDS <br /> lestncttons I certify and warrant that the waste has been treated in acoordance with the requirements of 40 CFA Part 268 and is no longer Ms-CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261 �C:rC CNS �.o y SA Y3 -CUBIC YARDS <br /> O -OTHER <br /> generator Authorized Agent Name Signature irr Shipment Date <br /> Am II Y TRANSPORTER(Generator complete a d, Yr`8 te'rr °tM) <br /> TRANSPORTER I TRANSPORTER II <br /> J T & f=r1 �` -,*I'- h Name <br /> As i Address <br />)river Name/Title � �f —1 1 Driver Name/Title <br /> PRINT/TYPE PRINTITYPE <br /> Shone No ZPz a Truck No i % k Phone No I Truck No <br /> lehicle License No !State Sf � —d _ m Vehicle License No !State <br /> kcknowledgement of Recept of Materials _ ___ Acknowledgement of Recept_of Materials0 <br /> No 8613014 <br /> BROWNING-FERRIS INDUSTRIES <br /> ._—• —� —`i Iii :t T 12 <br /> _`1S <br /> l.a�{d'�+c�l,' �Ei,3iti3j" 0< ��ilPf_ 11 _"''3r !grin-i, <br /> I: Li'iYUll� 1'1 GJ1 <br /> f 4 It } <br /> I 'P rEn Cl,-L'`v <br /> 1-es, 4 ZCV 4�-4 a lfa,trot—sr <br />..f C- i _�fl�l'�`7 '_-i' f.�F lei_`•� o>_-P <br /> 7ti a= f jp.2r y401 <br />)ail+„ ZO Y d c31e In # _Ca79 <br />)S= Wt Ta-e Wt• Net ;fit• to <br /> rGs`ild= r r?j ti riff } FxL'rdPJ <br /> --- <br /> 11-E C2 <br /> TC`al S lc5 t,`3 <br />