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. .n <br /> S .SPECIAL WA E & OS-MANIFEST <br /> 4.: <br /> e.:. Esb ,mmplet tr.� �4,. <br /> H •7s- u „ 'Yate,co a only dIII '7Y <br /> 0.512490 <br /> R � <br /> r' r <br /> a. Gener c. �• < :s. <br /> ngOr`TL9n• <br /> }$077 "36.t •w . - <br /> HG <br /> c. Address 51 #CA P <br /> S <br /> {925). 299-8891 )PAUL Will, k <br /> e. Phone No.: f.' Phone No.: <br /> If owner of the generatinngg tadlltt�y�di_ff�er�s from theggenerator provide[;; <br /> ARar t'RODtIClS CO*�ARtY sane ae4�) <br /> g. Owners Name: h. Owner's Ptidne No.', - <br /> O TYPE <br /> 4 0 5 0 6 1 "7 9 •9 DM-METAL DRUM <br /> I. BFI WASTE CODE e_c"..4 Containers DP -PLASTIC DRUM <br /> HON—HAZARDOUS SOIL-r•'- - r._•� B -BAG <br /> j. Description of Waste: k. Quantity- Units No. TYPE BA -6 MIL.PLASTIC BAG <br /> 0 0 HY 0 1 MO -OTHER or WRAP <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 UNIT <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,If the waste Is a treatment residue of a previously re7s acted hazardous waste subject to the Land Disposal Y -YARDS <br /> Restrictions,I cert and warrant that the waste has been treat in accordance with y1a requirements of 40 CFR Part 268 and is no longer a M' -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261. ,art r y at Cif ARCC7- �' mer' NY O -OTH RY CUBIC YARDS <br /> HELISS` KIRN/ DILLARD fi J'•,. � � _ �. <br /> Generator Authorized Agent Name SighaturC h' Shipment Date <br /> mpbTranser[complete eg - <br /> Section TRANSPORTER;{Generatorcote a-d; portnerIIcom h-n� <br /> TRANSPORTERI TRANSPORTERII <br /> a. Name: �77I �./1-n - h. Name: <br /> b. Address: 737Y/ Ate• i. Address: <br /> c. Driver Name/Trde: C SGA• T A 'i7 W11 -- j„: Driver Name/ihle: PRlrrrrtrPe <br /> PR�Ir•TITYPE <br /> d. Phone No.: tc o '4,7 e. Truck No.: k. Phone No.: I. Truck No.: <br /> I. Vehicle License No./State: flu 5 3 S O In.Vehicle License No./State: <br /> Acknowledgement of Receipt of Materials. Acknowledgement of Receipt of Materials. <br /> J/� I n. <br /> C G7 <br /> Driver Sin re Shipment Date I Diner Si nature Shipment Dale <br /> :SggSite Name:fion III: - OOA <br /> DESTINATION ;(Generatorcompletesa-d•destination she completese-t.) <br /> a. SBFI — VJSCrtD SANITARY LANDFILL c. Phone No.: (925) 441-0491 <br /> 40 .1 N. VA,SCO IRCA:> 4001 E. V.-:Z.CO <br /> b. Physical Address: d. Mailing Address <br /> LIV22MORE, CL 9 :550 I,IV'?3R_y'!a,:'; - yri550 <br /> e. 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 /> ' �;�BrY1007-11 <br /> . I `- _ / rnz aw—anon;: <br />