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' f l - - � � � � _- ��. ..� ....... ... .� � r� �rrrti� .. .'tip. ■ r. vi nvr■ry i VV ara�'a■■Iltlr�.s7 � <br /> If waste Is asbestos waste, complete Sections I, II, III and IV No. 780950 <br /> If waste is NOT asbestos waste, complete only Sections`, II and III <br /> action I GENERATOR (Generator comp"an of section <br /> Orator Name = / r/i2cJ/J�� 4 S/r b Generating Location �1i��=✓!2G'!� _ �5 �! �Z6�} <br /> Address �=% �c7 + 2_"f / -d Address 77 S <br /> l ✓ ,'�i9 <br /> Phone No c i Zf 2� - 66 S S f Phone No .l <br />)caner of the generating facility differs from the generator provide <br /> Owner's Name h Owners Phone No <br /> TYPE <br /> BF1 WASTE CODE Containers DM-METAL DRUM <br /> OP -PLASTIC DRUM <br /> - - B t BAG <br /> Description of Waste k Quantic �i Unds No TYPE BA -6 MIL PLASTIC BAG <br /> LC� I T TRUCK O OTHER WRAP <br /> GENERATORS CERTIFICATION t hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Part 261 UNITS <br /> or any applicable state taw,has been property described,classified and packaged and is in proper condition for transportation according to P -POUNDS <br /> applicable reputations 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 acdordance with the requirements of 40 CFR Part 268 and Is no longer M3-CUBIC METERS <br /> a hazardousi-ste as defined by 40 CFR Part 261 "e Y3 -CUBIC YARDS <br /> 2 r �v C O -OTHER <br /> (r <br /> uNi c�s�- d p s S <br /> Generator Authorized Agent Name Signature Shipment Date <br /> orter <br /> chon U _ TRANSPORTER(Generator compiete a-d,-Transits tom,n <br /> J TRANSPORTER I TRANSPORTER II <br /> Name y r �r `� h Name <br /> i <br /> I Address <br /> Driver Name/TitleG1 I r✓ rC(--r- �' i Driver Name/Title <br /> PRI T ITYPE I PRINTITYP£ <br /> Phone No e Truck No G k Phone No i Truck No <br /> dehicle License No I State '% I J <br /> m Vehicle License No /State <br /> Acknowledgement of Receipt of Materials Acknowledgement of Receipt of Materials <br /> No 8613121 <br /> BROWNING-FERRIS INDUSTRIES <br /> _ <br /> �taP tLl(I; C <br /> 'i 2r I, l.ys 4 <br />{ <br /> -Tr <br /> 11'=A � +��i2Y3Y" LH' +�ti�l�l•iR'i 1:H <br /> Gppr3far Zi L_-T 4 <br /> pac_tl - ?H.ve To Sca,e n R Sgale Cs. 4 J <br /> vss k{ Tare Wt- t' ilei A.1I tr, '� Ir f r f <br /> t t kc ija. B 11 )t I S 1+nI: Ex}ended <br /> 21 18 <br /> ,Udi, Ta' S a3.=i��tyy <br /> k <br /> Tata' S 126 N <br />