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# ON�IiAZAR `5pEC1AL NAS EESTO ANIFEST <br /> SectionS,i.� and tv -, ;, Qa <br /> , i + ^If vraste1sbestos waste,Complete only Sections i.TI <br /> PRODIIClB C70t1PAHY Q AROb;,MTION #04932 <br /> i CienetatorName. _ b. Generating Location <br /> 4 z�< <br /> ±Address :.POB .5Q77 ;4 ,d. Address. .. i» -� - <br /> SUM PARR+ CA, 90622-5077 � '* STOCkTm <br /> 1. Phone No.: - (925)' 299-8891,PAUL SUPPLE I. Phone No.: NSA <br /> I owner of the generating facility differs from the generator,provide: - <br /> I. Owner's Name: PRODUI;,T9 COMPANY h. Owner's Phone No.: _Sam*:'aD 1(e) <br /> C A 4 Q 5 0 6 1 7 9 O 2 1 0 9 � <br /> BFI WASTE CODE ' Containers DM-METAL DRUM <br /> _ DP.-PLASTIC DRUM <br /> NON—HAZARDOUS SOIL B -BAG <br /> ., Description of Waste: k. Quant' gnus- No. TYPE BA -6 MIL PLASTIC BAG <br /> E M. . WRAP <br /> 0 0 01 Y 0 1 ? T' -TRUCK <br /> O -OTHERR <br /> GENERATOR'S CERTIFICATION: 1 hereby certify that the above named material is not a hazardous waste as defined by 40 CFA Part 261 or UNITS <br /> any applicable state law, has been propedy descnbed,classified and packaged,and is in proper condition for transportation acoording to P -POUNDS <br /> applicable regulations;AND,It the waste Is a treatment residue of a previously restricted hazardous waste subject to the Laod Disposal Y -YARDS <br /> Restrictions,I certify and warrant that the waste has bee .ted' accordance with the requirements of 40 CFR Part 266 and is no longer a - M' -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261. S f. Y3 -CUBIC YARDS <br /> O -OTHER <br /> MELISSA KIRNI DILLARD <br /> yw <br /> Generator Authorized.Agenl,Name g, : '-s-,�'= - Shipment Date <br /> �' .. •� .;.�+ mN`-- nericom fete � ` �� "` � <br /> .x,�Generptor complete. rans�rter❑com lete <br /> -_J6AANN$ORTIEP.,I,„ TRANSPORTER II <br /> t. Name; L ►hh.Name:. <br /> r. Address: U, - - i..- Address: <br /> :. Driver Name/T-rtle:-- Qlh, '-C7tfiC'1A�. - J.,DriverName/Title: . . <br /> 'PRINTrrYPE PRINTfrYPE <br /> 1. Phone No.! '7L'7o _436& e. Truck No.:_S .k..Phone No.: I. Truck No.: <br /> Vehicle License NoJState: C19 g1T:I ` m.Vehicle License NoJState: <br /> AcknowlIedgement of Receipt of Materials. Acknowledgement of Receipt of Materials. <br /> I. iYt1criY1 n. <br /> DrFiw� netun Shipment Dale Dmrer signature shipmentDate <br /> to ESTINATIO rgoletea,�1?`a`.. Fn <br /> BFI — VASCO ROAD SANITARY LANDFILL (925) 447-0491 <br /> �. Site Name: - c. Ph�Wo.: <br /> t. Physical Address: 4001 N. VASCO ROAD d. Mailing Address 4001 N. VASCO ROAD <br /> LIVERMORE, CA 94550 LIVERMORE, CA 94550 <br /> •. Discrepancy Indication Space: <br /> I 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# 1007-114 <br />