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pn-n.q....nvw� �rtcv�Ea� rrwa 1" a �ao�a va mw��rca If WAS asbestos waste,complete Sections 1,11,111 and IV. N Q, 512457 If waste is NOT asbestos waste,complete only Sections 1,11 and III. 1 GENERATOR (Generator completes all of section q ARCO PRODUCTS COMPANY ARCO STATION #04932 /erator Name: b. Generating Location: Address POd SU 77 d. Address: 16 E. FLA.RDING BULZLA PARK, C4 90622-5077 GTOCKT'ON, CA e. Phone No.: (9-/5) 29'.—8891 PAUL SUPPLE f. Phone No.: N/A If owner of the generating facility differs from the generator,provide: g. Owners Name: ARCO PRO(`G'CTS COttPz�NY In. Owner's Phone No.: Same as I(_) TYPE L BFI WASTE CODE [q A 40 5 0 6 1 0 9 5 0 2 C 9 b Containers DM-METAL DRUM DP -PLASTIC DRUM CJOC7—FiA Z:.RDOUS SOIL B -BAG j. Description of Waste: k. Qu f u BA -6 MIL. PLASTIC BAG or WRAP C 0 0 Y 0 1 T T -TRUCK O -OTHER 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 P -POUNDS applicable regulations;AND,If the waste is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Y -YARDS Restrictions,I certify and warrant that the waste has been treated ip accordance with the requirements of 40 CFR Part 268 and is no longer a M3 -CUBIC METERS hazardous waste as defined by 40 CFR Part 261. at tW request Iof ARCO Ys -CUBIC YARDS MAT.TRSA KTRNI DTT.T.ApD ENVI % f /,' i .6 I ) °r 9 O -OTHER Generator Authorized Agent Name A Signature ( Shipment Date $ECtJ011�TI TRAWOORTIER``�derrerator�n kiwi f; TranSportertcdm (eteAg #R:?'-,�, t , ,c`�; �, 0 Trens rtertloo lets h-n u,� ?T^g a40 TRANSPORTERI TRANSPORTER II a. Name: DILLARD TRUCKING, INC. It. Name: b. Address: POB 579 i. Address: BYRON,, CA q /9451,4, c. Driver Name/Title: I fi 19 A �'• A 1W j. Driver Name/Tkle: 925-634-6850 PRINT/TYPE PRINTITYPE d. Phone No.: e. Truck No.: it. Phone No.: I. Truck No.: f. Vehicle License No./State: 5102 %0 Ss m.Vehicle License No./State: Acknowledgement Jof Receipt of Materials. Acknowledgement of Receipt of Materials. g. �h (/V O1hB\ 6 ' n. Drvrer nature SM Date Driver nature Shipment Date r O .wqP. (eaoms°7e"s ,. ,� E`5 1'IitltkTiO epsf3t cbm et ,+i'.t s p t �I vs -„ , _ ,� _ l . a. Site Name: BPI — VASCO ROAD SANITARY LANDFILL c. Phone No.: (925) 447-0491 b. Physical Address: 4001 N. VASCO ROAD d. Mailing Address'•` 4001 N. VASCO ROAD LIVERMORE, CA 94550 LIVERMORE, CA 94550 e. Discrepancy Indication Space: I 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 f �Z / PO# 09-30312 NarnecfAWwdzee Agent signature Receipt Date ' EL Shippers's•Name: to. Shippers's•Phone No.: M Shippers%-Address: jShp pers%Special HandlingInstructions and additionalinformation:TIFICATIONc. I hereby declare that the contents of this conslghment are fully and accurately described above by proper shipping name and are classifiedcd,and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.fpperssName aTtlePnnvTvne shlooers's sionaturs nares