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REPU ic 8 <br />BEAVVES <br />1005178 <br />NON -HAZARDOUS SPECIAL WASTE 8 ASBESTOS MANIFEST <br />If wage is asb&Mn *eMFPIS <br />1. it, III and IV <br />if as" is astxmos wgtft. Sedicns 1. i i and I I I <br />1. GENERATOR (Generator completes la -r) <br />a. Gensraboes US EPA ID Number b. Mmifgst Dacxxrie[+t Number <br />WA -1 <br />. Page 1 of <br />d.S�o��n � � � �' +�°": $ Std �e a LLe <br />14M W. HO*oy 12 � �°I -- � �'� ��� ► 39 00110=1104 Ass. SK Suite 200 <br />�oci� CA s6��Q Rapias. M �'3 b ! °r- �`��`t <br />I(nwner of the generating facility differs from We generator. provide: <br />h. C)vimer's Name: i. C)vrr+er's Phone No,-. <br />!- Waste PrDfte # !c. Exp. Date 1. Waste Shipping Name and <br />Desrxintion <br />m. Containers <br />Na. I Tvzx <br />a I D M <br />n. Total o, Unit <br />Quantity WtN01 <br />GENERATOR'S ERTIpICATIO1: I hweby offl* that the above is root a hazwdkxm wSSted0firied by 40 CFR1 or any aWiCk* <br />state law. hm teen property descifflmd. ckmsgied aM and is in prinier condWm for hweportationf to &PPk=bft rsgul tom# AND- If this <br />erste is a ttrrnt residue of a provkxx9y msuicted hazardom waste to the tares Diions. N " and waffant VW Ve waste has <br />been treated in a=rdanoe with the n9quiremnu of 40 CFR 268 and i r a h=ardous wasW as defies by 40 CFR1. ..— <br />� � � .� � • � fir. '- ��. �.r• .�� <br />r. Date <br />g,.__G9r*mrst,Dr Audoweized Nent Nam._(Pdnt) �qnvtu-4 <br />r <br />IL TRANSPORTERfiner Co lei fi-b and Tran r coMpletes l Icy <br />- Transportees Name and Address- 540ckoloe, P <br />- HI �IVVCAY a <br />t0i tcoa 9 7, 04f <br />b. Phone, " <br />c. [lover Name Print � � f d. S' na�ure --- e. DetD �'G � L <br />Ili. DE3TINATiON (Generator complete ma -c ana [3estinatian Site completes Ilkf-g) <br />a_ Disposal F and Site Address: c. US EPA Number d. E�iscx��ncy fnd+catian Spice: <br />Fvrwar+dte <br />S.AAaM Rd. <br />�r h <br />Nbli4elpev CAAM <br />2094*Q <br />#4M <br />b. <br />*0 above r� �1 ted f is <br />1ti <br />r � 6 r � r:1 <br />_*.4im-6eo horixed A ent JP&t <br />1V. SBESTOS (Generator completes Na -f and Operator 91) <br />a Operator's Name and Address. <br />i <br />esponsible Agency Name and Addrem <br />b. Phone-- --- _ -dPhone <br />Special Handling Instructions and Additional Information'. <br />x <br />A <br />ori- riaol El Bosh % Frim % Non -Friable <br />OPERATOR'S CERTIFICATION hereby declare Mat the contents of this consignment are fully and accurately descrited above by the propet shtppin narne� <br />and are classified, packaged, marked and labeled/placarded. and are in all respects in proper condition f f transport according to applicable inlernal;onai and <br />nallonaf f-ioyernmental rk �-u1atjo <br />_ Optarator's Borne and Tide 4 Fria(' h 3,i;nature _. ale <br />'Operator refers to the corepany WrIJ rr owns feeres, operates, c ntrojz;, or super-03es we fiauw inij %lemaijortic t. renoyaled. or the d rno ton or <br />r novallo ratocn or both <br />