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y � <br /> NON-HAZAREAS'SPECIAL WASTE- BESTOS MANIFEST <br /> ai. . . <br /> If waste is asbestos waste,complete Sections 1,R,M and IV. No. <br /> C n <br /> If waste is Q asbestostvaste,complete only Sections 1,It and IQ .. 57 L <br /> 497 <br /> -GENERATOR (Generator completes all of Section 1 1 ` <br /> ARCO STATION CG4932 <br /> a Generator Name: ARCO PRODUCTS CQ ANY b. Generating Location: <br /> c. Address FM 5077 d. Address: 16 E. HARDING <br /> BUENA PP-RK, CA 90622-5077 Sr14=110N, CA <br /> e. Phone No.: (925) 299-8891 PAUL SUPPLE f. Phone No.: "ISA <br /> if owner of the generating facility differs from the generator,provide: <br /> g. Owner's Name: AROD PRODUCTS COIiPAnY h. Owner's Phone No.: `� as I(e) <br /> 4 05 D6 179 9 2 09 TYPE <br /> i. BFI WASTE CODE Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> NOt7—HAZARDOUS SOIL B -BAG <br /> I. Description of Waste: k. Quant' gnus No. BA -6 MIL.PLASTIC BAG <br /> or WRAP <br /> 0 0 O Y 0 1 T 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 property 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 restilcted hazardous waste subject to the land Disposal Y -YARDS <br /> Restrictions,I certify and warrant that the waste has been Vetted ip eccertlance wkh Vie requiremens of 40 CFR Part 266 and is,no longer aM' -CUBIC METERS <br /> hazardous waste as defined by 440 CFR Part 261. OIC t 'e f ARCO PRODOCPS COHPACtY Ya -CUBIC YARDS <br /> f O -OTHER <br /> 1/ r, J <br /> MELISSA RIRNi DILLARD r 1l i <br /> Generator Authorized Agent Name Signature Shipment Date <br /> ti- , Tmnspoder I complete eq <br /> - <br /> Se Mw <br /> ctlOn II TRANSPORTER :(Generator complete a-0, Trans iter H complete h-n .R <br /> TRANSPORTERI TRANSPORTER 11 <br /> a. Name:4�4A 5/y / i/il ."r�r,.✓.i. ���rrs�i:.<,,.. J.ac In. Name: <br /> i. Address: l vn LC. '�- r F`.•< I. Address: <br /> ;. Driver Name/ritle: +-- ��''"' z•1 J. Driver Namerntle: <br /> - PflIM/rYPE PflINrlf1'PE <br /> J. Phone NO.. ,rte) �1 r. r c e. Truck No.: c K k. Phone No.: I. Truck No.: <br /> Vehicle License NoJState: 5a> 'L ` 'y m.Vehicle License No./State: <br /> ACknow(edgemerlt of Receipt of Materials. Acknowledgement of Receipt of Materials. <br /> f <br /> Driver Si nature Shi mens Date Dicer Si nature Shl ment Date <br /> Section III DESTINATION (Generator completes a-d,destination site completes e4.) ' <br /> t. Site Name <br /> BF1 VASCO ROAD SANIT4RY LANDFILS. c. Phone No.: (925) 447-04:1 <br /> 4',oI N. VA,-:CO ROAD 4001 N. VASCO ROAD <br /> �. Physical Address: d. Mailing Address <br /> LIVI RMORE, Cif 94550 Livm.`:ORF., G"f 94550 <br /> r. Discrepancy Indication Space: <br /> 1 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 /> PO$ 09-30308 <br />