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ON-HAZARD WASTE & �AESTOS MANIFEST <br /> If waste Is asbestos waste,complete Sections I,B,III and Iv. w 1 O. 512455 n A G C <br /> If waste is NOT asbestos waste,complete only Sections 1,11 and III. N J G 4 5 J <br /> :GENERATOR (GenemtorcompleesalloYseconp <br /> j ARCO STATION 404932 <br /> venerator Name: ARCCO PRODUCTS COMPANY b. Generating Location: <br /> .ddress .POB 5077 d. Address: 16 E. HARDING <br /> BUENA PARK, CA 9062-5077 uSTOCKTON, CA <br /> 'hone No.: (925) 299-8891' PAUL SUPPLE I. Phone No.: N/A <br /> I <br /> mer of the generating facility differs from the generator,provide: <br /> hvners Name: ARCO PRODUCTS COMPANY h. Owners Phone No.: Serge as I(e) <br /> TYPE <br /> IF]WASTE CODE C A 4 0 5 0 6 1 0 9 % 2 $ 6 Containers r DM-METAL DRUM . <br /> A �`' . .n gin !yr BP _BAG IAG-DRUM <br /> )ascription of Waste: NON-giAZARDOUS 5'b�ta":*-. k. Ouant' Units No. TYPE BA -6 MIL PLASTIC BAG <br /> 0 0 0 I N 0 1 FF] T -TRUCK <br /> O -OTHER or <br /> WRAP <br /> GENERATORS CERTIFICATION: I hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Part 261 or UNITS <br /> any applicable state law, has been property describetl, classified and packaged, and is in proper condition for transportation according to P -POUNDS <br /> applicable regulations;AND,If the waste is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Y -YARDS <br /> Restrictions,I certifyandwarrant that the waste has been treated in accordance with the requirements of 40 CFR Part 268 and is no longer a M' -CUBIC METERS <br /> hazardous waste as defined by 40 CFA Part 267. gt. ef Ye eSt r ARCO Y Ya -CUBIC YARDS <br /> O -OTHER <br /> MELISSA KIRN/ DILLARD ENVIROI <br /> l - b <br /> Generator Authorized Agent Name Signatur ; ''' \.. Shipment ate <br /> 'l, <br /> : <br /> -tion II Transporter <br /> TRANSPORTER (Generator Trans rterIilcocompletem letehe-gl-ri) <br /> TRANSPORTERI TRANSPORTERII <br /> —\ v, Lk h: Name:rA <br /> j <br /> ,ddress: TX. , I. Address: <br /> �. CA q4l�)\ A- <br /> j. Driver Name/Title: i <br /> giver Narrie/Tdle: PRRINrmrnE <br /> FiINT/rYPE i <br /> hone No.:q Z F'L"A 6-FOD a. Truck No.: k. Phone No.: I. Truck No.: <br /> ehicle License No./State: �Y 77 +r'( / m.Vehicle License NoJState: <br /> cknowledgement of Receipt of Materials. Acknowledgement of Receipt of Materials. <br /> n. <br /> river Si nature Shi mens ate Driver signature <br /> S1v nrerN Date <br /> lion.III DESTINATION (Generator completes a-d,destination$Uscompietes0-0 <br /> BFI - VASCO ROAD SANITARY LANDFILL c Phone (925) 447-0491 <br /> ,tte Name: - i <br /> 4. 01 N. VASCO ROADd. Mailing Address 4001 N. VASCO ROAD <br /> 'hysical Address: <br /> LIV13trv10RE, CA 94550 LIVERMORE, CA 94550 <br /> I <br /> iiscrepancy Indication Space: - I. <br /> hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate. <br /> JOBB 1007-111 <br /> ! NUF PG# 09-30312 <br /> ame of Arnhor¢ed Agent Signature f' Receipt Date <br /> 7tjorl IV ASBESTOS (Generator complete a-d,I.g,Shipper-completes e:) ` t <br /> I <br /> ,hippers's`Name: b. Shippers's' Phone No.: i <br /> hippers's'Address: i. <br /> hippers's Special Handling Instructions and additional information: <br /> TIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packaged, <br /> ed,and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations. 1 <br />