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. ® NON-HAZARAS SPECIAL WASTE 81: IAESTOS MANIFEST <br /> F <br /> If waste is asbestos waste,complete Sections I,11,I1I and W. NO- 512485 <br /> If waste is Q asbestos waste,complete only Sections L 11 and 111. <br /> -.GENERATOR (Generator completes all ofSectlon tj - <br /> ti. Generator Name: ARCO PROMM CCVWA.`7Y b. Generating Location: ARCO STATION #04932 <br /> c. Address 808 5077 d. Address: 16 E- HARDING <br /> BURSk PAR1Kr CA; 90622-5077 SROMTON, CA <br /> e. Phone No.: (925) 299-Ml-PAVL SUPPLE f. Phone No.: N/A <br /> If owner of the generating facility differs from the generator,provide: <br /> g. Owner's Name: 'i1= PRODUCTS MANY h. Owner's Phone No.: Sam as I(e) <br /> TYPE <br /> i. BFI WASTE CODE C A 4 0 5 0 6 1 7 9 9 0 2 1 0 9 Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> B -BAG <br /> j. Description of Waste: NON-BAZARDOUS SOIL k. Quantity Units No. TYPE BA -6 MIL PLASTIC BAG <br /> or C 0 0 2 0 1 TT O -OTHER WRAP <br /> GENERATOR'S CERTIFICATION: I hereby certily 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 oond'Rion 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,l certify and warrant that the waste has been�treated In accordance wit he requirements of 40 CFR Part 266 and Is no longer a M' -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261. ;a „the r _e f6f ARCO P Ys -CUBIC YARDS <br /> r ; � O -OTHER - <br /> MELISSA KIRK/ DZLLARD - <br /> r- &, Z � <br /> Generator Authorized Agent Name , g Inafoire Shipment Date <br /> Transporter I complete * �' <br /> SOCtiDf1R - ..TRANSPORTER (Ge mratorcompletea-d; Trans rteruco leteh-n' .. <br /> TRANSPORTER I / TRANSPORTER I[ <br /> a. Name: l�Lif�lri/:.:.1 r. ..,�t ,�a r�,.,i �!-�.rni %. f: h. Name: <br /> -:. <br /> b. Address: -12417(- -1 I. Address: <br /> c. Driver Name/fittle: j. Driver Name/rrtle: <br /> /�. PRINTfrYPE -� PRINTrrYPE <br /> d. Phone No.:, 0� " ? 7 / /O e. Truck No.: k. Phone No.: I. Truck No.: <br /> f. Vehicle License NO./State: lr l/l ���0 /`/ m.Vehicle License No./State: <br /> Acknowledig ment of ReleYt of Materials. Acknowledgement of Receipt of Materials. I--� <br /> Dever Si naNre Std mord Date Driver Signature Shi meet Date <br /> Section III ' DESTINATION (Generator completes a-d,destination sae completes e4.) <br /> a. Site Name: <br /> CP'1 - VAS-`n :-n;,D SANIT'RY LANDFILL c. Phone No.: (925) 447-0.191 <br /> 4001 N. V: rco R071D 4.-:G1 N. VASOD L'VvD <br /> D. Physical Address: d. Mailing Address <br /> LIVI~12MORS, CA 94550 LIVERHORF:, G', 94550 <br /> a. Discrepancy 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 /> -._ Jc,PR 1007-114 <br /> —' S Pof 09-303013 <br />