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NON-HAZARDf-PASPECIAL WASTE & APESTOS M,,4NIFEST <br /> If waste is asbestos waste,complete Sections I,IL III and IV. N Q. 512458 <br /> If waste is NOT asbestos waste,complete only Sections 1,11 and III. <br /> on`I GENERATOR.Qeneator''comoletesanofsecton'n, " *,- <br /> 3enerator Name: ARCO PRODUCPS COMPANY b. Generating Location: ARCO STATION #04932 <br /> POB 5077 16 E. HARDING <br /> Wdress d. Address: <br /> BUENA PARR, CA 90622-5077 STOCKTON, CA <br /> 'hone No.: (92 ) 299-8891 PAUL SUPPLE I. Phone No.: N/A <br /> vner of the generating facility differs from the generator,provide: <br /> )wnees Name: ARCO PRODUCTS COMPANY h. Owner's Phone No.: Same as I(e) <br /> MP <br /> C A 4 0 5 0 1 6 1 1 0 9 1 9 0 2 1 0 9 6 1 TYPE <br /> IFI WASTE CODE Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> NON—HAZARDOUS SOILB -BAG <br /> )ascription of Waste: k. Quant' UnitsNo. TYPE BA -6 MIL PLASTIC BAG <br /> 0 0 0 Y 0 1 Tor WRAP <br /> T -TRUCK <br /> O -OTHER <br /> 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 <br /> any applicable state law, has been properly described, classified and packaged,and is in proper condition for transportation according to P -POUNDS <br /> applicable regulations;AND,N the waste Is a treatment reslduef f a previously/restricted hazardous waste subject to the Land Disposal Y -YARDS <br /> Restrictions,I candy and warrant that the waste has beefftip ecwroance ah the requiremems of 40 CFR Part 266 and is no longer a M' -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261. ' i e Of ARCO PRODUCTS COMPANY Ys -CUBIC YARDS <br /> AELISSA KIRK/ DILLARD :' Q 6 FIT/ 9 G O -OTHER <br /> Generator Authorized Agent Name /Sig azure Shipment Date <br /> piete <br /> CtionII TRANSPORTER (Generator completes d, TrensporterIcom <br /> Transporter ti cora leteh-n) <br /> TRANSPORTERI TRANSPORTERII <br /> DILLARD TRUCKING, INC. <br /> Lame: h. Name: <br /> POB 579 <br /> Wdress: — i. Address: <br /> BYRON, CA 94514 <br /> )rver Name/rfle: AWATSc- j: Driver Name/Tltle: <br /> 925-634-6350 PRINrfryPE PRIWtrYPE <br /> 'hone No.: e. Truck No.: 4 k. Phone No.: I. Truck No.: <br /> 'ehicle License No./State: S142'90'65 m.Vehicle License NoJState: <br /> acknowledgement of Receipt of Materials. Acknowledgement of Receipt of Materials. <br /> 0-4 .. Now B is I I191r, n. <br /> river Si nature Shipment Date Dnver Si nature Shipment Dale <br /> Ctlon III DESTINATION (Generator completes a-d,destination site completes'e-f.) <br /> BFI — VA:dCO ROAD SANITARY LANDFILL (925) 447-0491 <br /> ;ite Name: c. Phone No.: <br /> 4001 N. VX CO ROAD 4001 N. VASCO ROAD <br /> 'hysical Address: d. Mailing Address <br /> LIVFRMORE, CA 94550 LIVERLM01'E, CA 94550 <br /> liscrepancy Indication Space: <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 /> JOB# 1007-111 <br /> j I I �4Z444715 PO# 09-30312 <br /> arae of Authonzea Agent Signature Receipt Date <br /> ,tion N -ASBESTOS (Generator complete a-tl;f,g,Shipper'completes e.)f, <br /> .hippers's*Name: b. Shippers's*Phone No.: <br /> hippers's*Address: <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. <br />