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REPUBJ.1C� NON-HAZARDOUS SPECIAL WASTE & ASBESTOS MANIFEST <br /> SERVICES <br /> 55206 r If waste is asbestos waste,complete Seotiona I.il,III and tV <br /> If waste Is NOT ap,smtos waste,o mplele Sections I,It and III <br /> I. GENERATOR (Generator completes to-r) <br /> a.Ganeratol°d U8 EPA ID Number b.Manifest Document Number C.Page 1 of <br /> :l <br /> d.Ganeratt '�r t�QJ Jtxrrpefty Inc) e.Generators <br /> r s: <br /> "0% 'TE(Formally BJJ Cwpany Inc) <br /> 2347 E.Wrip=Rd, P.O.Box 30 010 <br /> f, Phone: Skxktdt,CA IitM <br /> .Phone: ftckitut,CA W3 209-9414M1 <br /> If owner of the 9848ratklg facift Mars from the generator,provide: <br /> h.Owner's Name; i,Owner's Phone No.: <br /> J.Weds Profile 0 k.Exp.Dale f.waste Shipping Naive and m.Containers <br /> Des tion n.Tafel o.Unit <br /> No. T 4uenti wwol <br /> CW U I Y <br /> GENERATOR'S GERTIF'ICATIt3f+1: I hereby o&mry that ma ahave named mater4af la vola hazardous waste ae(Wf$ad by 40 CFR 281 or any applicable <br /> state law,has been properly described,dasslAed and packaged,and is In proper condition for transportation according to appifoable regulations;AND,If this <br /> waste is a treatment residue of a previously restricted hazardous wstrte subject to the Land Disposal Restrtctloris I Certify and warrant that the waste has <br /> been treated in accordance with the re ulremente of 40 CFR 2$8 and l o longer a hazardous waste as defined by 40 CFR 2131. <br /> r <br /> Generator Authortw Agent Name Pdnt ,Sion r.Date <br /> Il. TRANSPORTER Gene for COM 1#ftes 11a.1h and Trane r#er complatae 1!c-e <br /> a.Transporter's Name and Address: <br /> b.Ph no: <br /> c.Drive ams nei-ii d,S Hato 9,Date <br /> 131. DESTINATION (Generator complete Illa-c and Des tinaklon $lte campltes Illd-g) <br /> a. 040601 Facility and 31te Address: c.U9 EPA Number d,Discrepancy Indication space: <br /> Fi7nmilyd UWKN <br /> 8 Agin Fill. <br /> b. <br /> i hereb malarial a the bast of kno the Is trcro and aemni e, <br /> AL _ <br /> e.Name of A h xed A Frit in store .Data <br /> IV. ASSE-ST08 (Generator completes IVa-f anO Operator complete IVg-i) <br /> [Ib... <br /> Lho <br /> or's Name and Address: o.Responsible Agency Name and Address: <br /> d.Phone: <br /> Han <br /> Inatruc uOns and Additional Inforrrratror►: <br /> f. FrIable 171Non Fiable © Both 95 F labia % FrI <br /> aMo <br /> LWERATOR'S CERTIFICATION:I hereby declare that the contents of this canslgnmsnt are ANY and accurately asacribad above by the proper shipping name <br /> and are classilled,packaged,ma*ad and labefedlplaaarded,and are In all respects in proper condwon for transport according to applicable International and <br /> national jovernmerLigi regulations, <br /> G d.0 raIcWs,Name and Tftle Pint h.signe I.date - <br /> `Operalor re era to the company which owns,leekees,opsratps,controls,or supervises the facility being demolished or renoval ,or the darnatllton or <br /> renovation operation of both <br /> R0104 <br /> DESTINATION RETURN <br /> RS-FiiA <br />