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.LARIJ%S SPECIAL WASTE & RESTOS MANIFEST If waste is asbestos waste,complete Sections 1,11,111 and IV. N�. 512467 If waste is NOT asbestos waste,complete only Sections I,II and III. GENERATOR (Generatorcompletes all of Section 0 ame: ARCO PPODUCPS COMPANY b. Generating Location: ARCO STATION #04932 POB 5077 d. Address: 15 E. HARDING BUENA PARK, CA 9062: -5077 STOCKION, CA e. Phone No.: (925) 29' -8891 PAUL SUPPLE I. Phone No.: N/A @owner of the generating facility differs from the generator,provide: g, Owner's Name: AP.CO PRO::UCi S COE•2P NY h. Owners Phone No.: Same as I(e) TYPE i. BFI WASTE CODEC A 4 0 5 0 6 1 0 9 0 2 0 9 6 Containers DM-METAL DRUM DP -PLASTIC DRUM B -BAG I. Description of Waste: NON—HAZAP.IYJUS SOIL k. Quantity Units No. TYPE BA -6 MIL. PLASTIC BAG or F0 1 M T -TRUCK 0 -OTHER WRAP GENERATOR'S CERTIFICATION: I hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Part 261 or UNITS any applicable state law, has been property described,classified and packaged, and is in proper condition for transportation according to LM3U -POUNDS applicable regulations;AND,If the waste Is a treatment residue of a previously restricted hazardous waste subject to the land Disposal -YARDS Restrictions,I certify and warrant that the waste has been treate to a rdance with the requirements of 40 CFR Part 266 and is no longer a BIC METERS hazardous waste as defined by 40 CFR Part 261. 1 /tl e e 6 F ARCO P r,t UBIC YARDS T � THER Generator Authorized gent Name Signature Shipment Date Transporter i complete 29 arx,4G „ W-001111111 ' $esti©nII Tf' , rtn, kTFANSPORTER'(Ganeatwc«npietead: rmns rterncomplete hn�r— ,. ' . _ TRANSPORTER t TRANSPORTER H a. Name: DILLARD TRUCKING, INC. h. Name: - D. Address: POB 579 I. Address: BYRON, /A'CA 94514 c. Driver Name/Title: R . A yvA Imo^ j. Driver Neme/T'Ne; - - 925-634-6850 PRINT/TYPE q 4 1 PRINTITYPE J. Phone No.: Q e. Truck No.: k. Phone No.: I. Truck No.: Vehicle License No./State: 5T ^� d 1'S CA IT.Vehicle License No./State: Acknowledgement of Receipt of Materials. Acknowledgement of Receipt of Materials. 611 n.r g Driver g nature (�,/��^ 6hl ent Data Diner Si nffiure hipmeal Date a. Site Name: BFI — V.aSCO ROAD SANITARY LANDFILL c. Phone No.: (925) 447-0491 o. Physical Address: 4001 N. VASCO ROAD d. Mailing Address 4001 N. VASCO ROAD LIVERMORE, CA 94550 LIVERAfORE, CA 94550 a. Discrepancy Indication Space: hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate. JOB@ 1007-111 l PC# 09-30312 Name ofAulhahed Agent signature Recelp Dele ��,,yyrr,ty -.,�J .�r+.x,,�"', ttt?.�a` xk f E O$ 4Geri..'�= s:A f..9 SAippefYcgnfPlafea�,-. , s .. 4 e. ShippeWs*Name: b. Shippers's*Phone No.: ;. Shippers's*Address: J. 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.