COMPLIANCE INFO_2015-2016 - Laserfiche WebLink

Home Browse Search

i. k4*91T SERVICESREPUBLIC NON-HAZARDOUS SPECIAL WASTE &ASBESTOS MANIFEST l i + 2314918 lf•waste is asbestos waste,complete Sections I,ll,III and IV U If waste is NOT asbestos waste,complete Sections I,11 and ill ,a - i GENERATOR (Generator completes la-r) r arator's US EPA ID Numberb.Manifest Document Number c.Page 1 of ..j•:1r:. erator's Name and Location: e.Generator's Mailing Address: �;iz:r'r yllit7fiil= I_ -f rjrni rl�;'Valis 4Orij8lllu5 -s �.:• , J I-I�ysVd�t I~d�=tj;er[_�:�1i1'<:tfil��(.t_(�C_i,�ir::f#j Vyllc;'L)E�ptiis.�.l �i1�F.n,varf l d 016 Frawart Rd. e: L>;thl op,J'_'A 9&330 g.Phone: Lathmp,CA WY10 2179-982-136i or of the generating fatality differs from the generator,provide: er's Name: i.Owner's Phone No.: e Profile# k.Exp:Date 1.Waste Shipping Name and m.Containers n.Total o.Unit Description No. Type Qua Wt/Vol RO l O 4204/113380 VI arM 18 ',.�'le—thered Wood 2ATOR'S CERTIFICATION: I herebycerci thaTth abov d material is not a hazardous waste as defined by 40 CFR 261 or any applicable cw,has been properly described,classifiand pac ed,an pro on for transportation according to applicable regulations;AND,if this s a treatment residue of a previously restricted h ardo ste su ec to the La d Disposal Restrictions.I certify and warrant that the waste has ` 'eated in alcor ce with the rt1e uireme�ts of 40 R 26 n er a ha, us wase as defined by 40 CFR 261. �T erator Authorized Agent Name Print a r.Date TRANSPORTER Generator com I es Ila-b and Transporter tom fetes lic-e sporker's Name and Address:wA$,r' XevL �• ne: 3r Name Print d.Signature I e.Date DESTINATION (Generator complete Illa-c and Destination Site completes Illd-g) i ,osal Facility and Site Address: c,US EPA Number d.Discrepancy Indication Space: For.wf,'UandlFll M4`'S,Austin Rd. p certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurat s ie of Authorized Agent Print f.Signature .Date 11 it ASBESTOS (Generator completes IVa-f and Operator complete IVg-i) rator's Name and Address: c.Responsible Agency Name and Address: lr ne: d.Phone: tial handling Instructions and Additional Information: riabie O Non-Friable ❑ Both %Friable %Non-Friable ` 4TOR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name e classified,packaged,marked and labeled/placarded,and are in ail respects in proper condition for transport according to applicable international and i at governmental regulations. +.... q-y- rator's Name and Title Print h.Signature I.Date ctor refers to the company which owns,leases,operates,controls,or supervises the facility being demolished or renovated,or the demolition or x= lion o22radon or both 4 ,o 71 i, .!:'�i�i 3='1LRf I RS-F11A t