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rAddress <br /> NON-HAZAR� SPECIAL-WASTE & STOS MANIFEST <br /> If waste is asbestos waste,complete Sections I,B,III and IV. No- G9 2IIO7 - <br /> ff waste Is NOT asbestos waste,complete only Sections I,H and III. ,`� J.L 'iO 1ENERATORe: ARCO PRODOM COMPANY b. Generating Location: ARS S'h1TION N04932 <br /> PW 5077 16 R. HARDING <br /> d. Address: <br /> SUM PARK, CA 90622-5077 STOC=<)N, CAA <br /> Phone No.: (925) 299-8891 PAUL SOPPL6 I. Phone No.: N/A <br /> owner of the generating facility differs from the generator,provide: <br /> Owner's Name: ARCO PRODUM CCHPANY h. Owners Phone No.: Santo as I(e) <br /> Cm 4 05 06 179 9 2 09 TYPE <br /> Containers DM-METAL DRUM <br /> BFI WASTE CODE <br /> DP -PLASTIC DRUM <br /> NON—HAZARDOUS SOILB -BAG <br /> Description of Waste: k. Quant' Units No. BA -6 MILor WRAP PLASTIC BAG <br /> 0 0 0 Y 1[;PI <br /> T T -TRUCK <br /> O -OTHER <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 condition for transportation according to P -POUNDS <br /> applicable regulations;AND,H the waste Is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Y -YARDS <br /> Restrictions,I certify and warrant that the waste has been. in axordance the requiremems of 40 CFR Part 266 end is no longer a M' -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261. / he req of ARCO �PRODUCTS COMPANY Y3 -CUBIC YARDS <br /> !�./•'! .� , O -OTHER <br /> kFli.SSA 1:IRN/ DILLARD <br /> Generator Authorized Agent Name ` iSignature Shipment Date <br /> Transporter I:9mplete eg <br /> TRANSPORTER (Genermorcomplete ad, Tmns 111:Ito leteh-o .- <br /> f' TRANSPORTER I TRANSPORTER H <br /> Name: //- / �� ^ � - j h. Name: <br /> I. Address: <br /> Address: r, <br /> Driver Name ride: ti�,-�L x 1. DrNer Name/Title: <br /> It'rPE PRINf/r1'PE <br /> Phone No.: '% "` e. Trude No.: % k. Phone No.: 1. Truck No.: <br /> Vehicle U*nse 6istate:T� .�3 ,K`!7 m.Vehicle License NoJState: <br /> ll <br /> A k W iede g ' en�Receipt%Nvlaterials. Acknowledgement of Receipt of Materials. <br /> i <br /> /. / n. <br /> Dmer Si retire l—T— Shl meet Date Dm S' "Wm Shl meet Dale <br /> _ .. .w i'. .- r <br /> ection III DESTINATION (Generatorcompletesa-d,destinahonsrtecompleteset) <br /> B"I VA.SCO ROAD 61041TARY LANDFILL (925) 447-0491 <br /> Site Name: c. Phone No.: <br /> 4001 N. VASCO ROAD 4001 N. VA.^>CC, I':'AL, <br /> Physical Address: d. Mailing Address <br /> LIV132r10Rli, (:A 94550 LI'V;'::tAOREr ^..T. 9455 . <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 /> JOB4 1007-134 <br /> �% - j iDO 09-31130R <br />