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..r:r.a kyj,: �, -• n � rx _: .. . tv tea.`i- - - a -�x � ,yP s Y %�:. .'. •�.. � %.��Si`S t. � zea., � S�5 S g , ka•:w,��ns � �Y i�r s �x7 a heto3waste,complate ons ZV a �- �;,• '�"'-. -" �`�f waste a'.LLQT asbestos waste,complete Doty SocCiors f,II and III:; �O 1L, ..a= PROD[II�B .0 -� b. Generating Location: 0 - ARCO STATION x04493 _ Generator Name:, - - - Address .'008,,5077 d. Address: 205NORTH CSNTSR 6tRSET t. BIIStA PaRIC� CA., 90622—v077 a Phone No.: (925) "299-8691 PAUL SUPPLE f. Phone No. N/A owner of the generating facility differs from the generator,provide: Owner's Name: ARS PRODUCTS COMPANY. h. Owner's Phone No.: same az i(e) Ing ." BFI WASTE CODE 4M0 .5 0 5 O 6 1 0 9 0121 01914 - Containers. .. DM-MEfAL DRUM DP -PLASTIC DRUM B -BAG Description of Waste: SOIL k. Quant unas No. TYPE BA -6 MIL PLASTIC BAG or WRAP 0 0 0 0 `� Y 0 1 T T -TRUCK O -OTHER GENERATOR'S CERTIRCATION: 1 hereby certify that the above named material is not a hazardous waste as defined by 40 CFA Pad 261 or UNITS any applicable state law,fres been properly described,classified and packaged, and is in proper condition for transportation according to P -POUNDS applicable regulations:AND,H the waste k a treatment roeldue of a previously restricted hazardous waste subject to the land Disposal Y -YARDS - Restdctions,I certify and warrant that the waste has been treated In Pcoordance wait a jeciuffemenis of 40 CFA Pad 268 and is no longer a M' -CUBIC METERS hazardous waste as defined by 40 CFA Pan 261. D PRODUCTS COMPANY Ys -CUBIC YARDS zmz= O -OTHER JAELISSA XIRN/ DILLARD - - - Generator Authorized Agent Name S' Shipment Date 9777�. .- „ �—,- . .:-r.. • TrensWder Icortiplete e0 s a;.' • ' ' T_ •:-:TRANSPORTER (Generator completea-d;.Trans erucom latah-n ?�--- • - TRANSOORTERI TRANSPORTER 11 Name: 11 I u:- h. Name: Address: i. Address: Driver Name/ft8LL 0 •. +0(_— I(m j. Driver Name/Title: PRIMlrYPE PWNUfY� . Phone No.: e( Truck No.:� k. Phone No.: I..Trude No.: Vehicle License No./State: 3/j� (1/1�? m.Vehicle License NoJState: - Acknowledgement of Race, t f Materials. Acknowledgement of Receipt of Materials. `•� tl� V b 1 n. ' Orbx- Sft' Dale Dmer S nature Sn� my t Date =DESTINATION (GererStorcompletess-d,destimation site completes e-t) Oji. : •- •: a.^ z=al .':`--: BPI — VASCO ROAD SANITARY LANDFILL c. Phone No.: (925) 447-0491 . Site Name: Physical Address: 4001 N. VASCO ROAD d. Mailing Address 4001 N. VASCO ROAD . LIVERMORE, CA 94550 LIVERMORE, CA 94550 . Discrepancy Indication Space: I hereby certify that the above named material has been accepted and to the /best tooff mmy7knowledge the foregoing is we and accurate.OB0 1007-112 // 7 / S p0/ 09-30313 Name or AAnorze4 Agent Signature —�� Reoeipt Data DectionIV ASBESTOS {Generatorco pleteaE,f,g.Shlppeommpletese.) i. Shippers's•Name: b. Shippers's' Phone No.: % Shippers's•Address: I. Shippers's Special Handling Instructions and additional information: :ERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packaged narked,and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.