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�+ ON_=HAZAR��WUS SPECIAONO.- VSBESTOS MANIFESY <br /> bestos <br /> F4 wtiste LdQj esbestdawta�fe -611162 <br /> -a-- ----- tea `; s i`Sa--. .STATION #04493 <br /> .b� lleneratlnblbcaffon. <br /> 5 :: POB .3077 _ <br /> �:c.+Address • `' ., a£I•dAk,eldress _ __ . 205-°1'JORTH_CrftTM STREET <br /> BQRI�:'PARR, CA 90622,SO .,., SY'OCKTd1i <br /> e. Phone No.: (925). 299-8891 PAUL SUPPLE <br /> - H L Phone No.: N/A owner of the generating facility differs from the generator,provide: - <br /> g. Owners Name:ARCO PRODUCT'S CIWANY .Same as I(e) <br /> ��] �h. Owners Phoria'No.: <br /> I. BA WASTE CODE m � N p h {7 S I 0 0 TYPE <br /> Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> J. Description of Waste: NON-HAZARDOUS SOIL B -BAG <br /> k. QuantityO BA _6 MIL PLASTIC BAG <br /> or WRAP <br /> T -TRUCK <br /> O -OTHER <br /> GENERATOR'S CERTIFICATION: I hereby eerily that the above named material is not a hazardous waste as defined by 40 CFR Part 261 or UNITS <br /> applicablee reg <br /> any applstate law, has been properly described, classified and packaged, and is in proper condition for transportation according to P -POUNDS <br /> egulations;AND,H The waste Is a treatment classified <br /> of a prevtau restrlctetl hazardous waste subject to the Lard Disposal Y -YARDS <br /> Resardous ,I waste <br /> as and warrant that the waste has bee ate n aoconlartce a reyuiremerrts of 40 CFR Pert 2ti8 and is no longer a M' -CUBIC METERS <br /> hazardous waste as defined by a0 CFR part 261. raga s � PROtW'�-' J Y° .CUBIC YARDS <br /> MELISSA KIRN-DILLARD / O -OTHER <br /> Generetor AuNonzed Agent Name S. <br /> n re Shipmem Date <br /> - -4-0 SPORTIER: POWSW <br /> Genernla o0 "i r rnte`n iere" it- <br /> .• x <br /> TRANSPORTERI - - <br /> a. Name' TRANSPORTERII <br /> DUJJM TRUCKING, INC. <br /> It. Name: <br /> POS 579 <br /> b. Address: i. Address: <br /> JISTMON, CA 994514 <br /> j.-:Driver NamefMe: , <br /> 925-634-6850 PTNT ;�_� PfaNTMWE <br /> d. Phone No.. k. Phone No.: I. Truck No.: <br /> t. Vehicle LicenseNo./State:S/O28/7 ��9/ m.Vehicle License No./Smte1% <br /> Acknowledgement of Receipt of Materials. Acknowledgement 01fibi of Materials. <br /> --�� -- n. <br /> mem Date Omer a' name. Ni Daze <br /> a. Site Name: <br /> BFI - VASCO ROAD SANITARY LAND) <br /> ILL r (925) 447-0491 <br /> c. PhoneNo.: <br /> 4001 N. VASCO ROAD <br /> b. Physical Address: d. Mailing Address 4001 N. VASCO ROAD <br /> LIVFRMORE, CA 94550 LIVERMORE, CA 94550 <br /> e. Discrepancy Indication Space: - <br /> I hereby certify that the above named material <br /> L <br /> Name of Auawr¢ed Agent _ <br /> i .A$13_ hippe,�comPietes.a <br /> a. Shippers's*Name: b. Shippers's*Phone No.: <br /> :. ShippeWse Address: <br /> J. Shippers's Special Handling Instructions and additional Irjformatiom •' - f <br /> �11FlCATION: I hereby declare that the oontert s of tttis fully wee accumadey desaibod abovr, 'r <br /> Torked,and labeled/placarded,and are in all respects in proper mr kbon foF arm �� e��Bassi,. <br /> .aarsport according to applicable international and national go..errvrerrtal regtiatiors. '. <br />