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s-h i NON-HAZARDOUS SPECIAL WASTE,]& ASBESTOS MANIFEST i N vomits is asbestos waste,complete Sections 1,11,111 and N. O. LA O If waste Is NOT asbosigs Asia,complete only Sections 1,R and 111. Secy A- a. -a. Generator Name: b. GeneratingLocation: Co 'A'Cl3,1' l� 3Z- c. AddressPso0-7 .d.Address: .l(o 't= 6JGroA PAQ-V-�], tC , 4obZ2.-50-R c°��c\`r'r�ra CA e. Phone No.: 5�Z�7 c�CJ7 QAVXWC {�(� 1. Phone No.: If owner of are generating facility differs from the generator,provide: A2� QRoodCn ConnPAnt/ / 9� hers Name: h. Owfrefe Phone No.: cS TVV�I-.1cS �Ll C) - ' I. BFI WASTE CODE C n 4v $ b (1 Q (7 9 Containers DM-ME 1:LLDDRUM.. . DP-PLASTIC DRUM 1. Description of Waste:&n1�.�Q7A ` .]S \l., k.;0uant Unb Na. TypE Bp:BAG 6 MIL PLASTIC BAG TR K O -OTHER GENERATOR'S CERTIFICATION: I hereby catty'that the above named material le not a hazardous waste m delved by ere CFA Pan 261 or UNIT$ any applicable stele law,has been properly described.Washed and packaged,and b In Prober condition for aemportedon aewtding to P -POUND$ applicable reg estions:Alio,N Me waste la a tree F�d,of a prnl y reabteled hamMow weeN wblea b the larM Dblaosel V -YARDS Restrictions.I ceMy and warrant sat Me waste hasIn exothe regulrememe of 10 CFR Pan 266 and le no longer a - Mr •CUBIC METERS leuvrdous waste as defined by ee CFR Pan 261. Ver -CUBIC YARDS � O .OTHER Usne"AutharbadAgartName ShIPmant Data Secgo�� \ AFIS�TOk7E��aai a�� .• to , TRANSPORTER] TRANSPORTER❑ a. Name: - ALCU_AlTY h. Name: b.Address:_Po.. T3 A X i TO w L Address: i S n7 r.v T/Li` i- c. Driver Name/ride: /i iiailf.a�Y%"+"' ..'....< l ^ � y:-Odver NemeRitle:_ III. Phone No.: d-er O -)Z/-/♦1 O 9,Truck No.: 7 2 L - k. Phone No.: I. Truck No.: — f. Yehicie Uceose No./Stete: S090 s dlw. ,`FT 5-1 P 7J pl Vehicle Uceme NojSbSs::. Ackrlowiedgement of Re eipt of Matedals. // - AcknowledgemerA of Receipt of Materials. V - - g,omen 2 3 /q n, orn.. oTTTT--Fl 5ebiibrf-ltt(y• p ESTINA t31N- . 9. Site Name: +" LQ \�\Q T-dli 1. Phone No.: b. Physical Address:��\ Pao D d. Mailing Address qco\ Gk %Ss o L� ea of c k CA l 45so e. Discrepancy Indication Space: I hereby ceniy that the above named material has been accepted and to the best of my knovAedge Ne foregoing Is bum and accurate. �. -?17F I Nwmaeuw,nea Mem Sgrren meoxpee. SectionIV..;.. a. Shippers4`Name: - 1' b. Shlppers's-Phone No.: c. Shippers'se Address: d. ShippeWs Special Handling Instructions and audit Information: CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packaged. marked,and Iabeledlplacarded,and are in all respects in proper conddion for transport according to applicable International and national governmental regulations. , e. ShippoWs•Name&The: NMRype aNPPMVY SlerreNe Mia L Name and Address of Responsible Agency: g.❑ Friable; ❑ Non-friable; ❑ Both %Mable %nonflable ` Shipper talars to me company which owns.leases,operates,ovarals,or aeparvess are facility being demoilehed or renovated,or the demolition or renovation operation,or bond.