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'AR1�{1 S SPECIAL WASTE & _ SBESTOS MANIFEST <br /> pZ <br /> " 1f waste is asbestos waste complete Sections I U LII and IV No. 9 O 7 G O 7 <br /> ' ylf waste is fit I asbestos waste complete only Sections 1 It and III <br /> jA GENERATOR tGenerawroomplstesaltd��ecoor+q <br /> iQtt vrsv ur ' to �) + b Generating Location <br /> ._,n 7LSi <br /> $III nr g 3jsr tndLitit& eat rtd Address �r>> C''tit,rry CItilt 13l 1 <br /> HOuatun 'YS 7,-,Z7_--2IRl3 Fut r (wI i .e <br /> e;phone No <br /> (71,31 G,o-T'G 4 f Phone No r 1 <br /> tfuwner of the generating facility differs from the generator provide <br /> ...4 ¢ t Satyr I <br /> b,Owners Name E-,,011 Coilov it1V L h Owner's Phone No <br /> TYPE <br /> I 0 0 G a 9 tt Containers DM-METAL DRUM <br /> x G,13Fl WASTE CODE DP PLASTIC ORUM <br /> B -SAG <br /> Non. Ijazat duu9 Suit k ml;E <br /> UnM No TYPE BA 6 MIL PLASTIC BAG <br /> -`} Dexnptlon of Waste T TRUCK or WRAP <br /> a.k_ a i] 1 <br /> El O OTHER <br /> GENFAATOfi'$t"•F3iTIFICATION I hereby costly mat the above named material is not a hazardous waste as donned by 40 CFR Pan 291 ar <br /> U NITS <br /> state law Ices been properly descnhed classified arid packaged and Is in proper condition for transportation according to P POUNDS <br /> any applicable ous waste subrect to the land Otspoaar Y YARDS <br /> appileable,,ragulstions,AND,K the waste is a treatment residue of a previously restricted hazardCUBIC <br /> t 0&"and warrant that the waste hag been treated m accordance with the requirements of 40 GFR Part 263 and is no longer a -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Pan 261 8t L1y•' I c]ltr5t o! E�Kon +_Unrn�nV t 1 O OTHER <br /> rr -i T- a L' r Y <br /> S nature Shtpmttrtt Date <br /> �.,Caerterator AfNtofaad Aga Name e 4 1!F T.sL <br /> 7rartspatea I complete•'g <br /> ANSPORTER GonaratorcompietewcL T r6 completeh;A <br /> - TRANSPORTERI TRANSPORTERII <br /> r - Dillard Trusk1113 Int h Name <br /> a_Flame <br /> !t - P 0. SOX 210 t Address <br /> b Address <br /> 8�tort CA 94313 <br /> Driver Name/Tide PRINTlTYPE <br /> c Driver Namemtle PRINrrry <br /> S 10 ''1- '``` k Phone NO I Truck No <br /> d Phone No a Trunk No <br /> f Vehtde License No./State �� - �� — m Vehicle License NodState <br /> Acknowledgement of Ft t of Matenals Acknowledgement of Receipt of Materials <br /> F n or Dai. <br /> gDrN $iii 1 Date 6rWW 51 ivture <br /> SraGw DESTINATION (Generatwoorrrpienn"dastlna Maimowrlpwtesed) <br /> RFI L'1stn Rd 1,3tIt31311 "3t}i 11-1 ,r )1 <br /> ' c Phone No <br /> a Site Name <br /> 4001 Notth ' Uat t koati .40r,I vel ''I %a:, a hug, <br /> d Mailing Address <br /> b Physical Address N [ I e t tee l v Jif <br /> ' [1 rtarulc C1 Iii- rD <br /> e Discrepancy Indication Space <br /> and to the hast of my knowledge the foregoing is true and accurate <br /> I hereby certify that the above named material has been accepted <br /> iIIFOS 09--_0 In <br /> t Siytewn . aatagt Data <br /> II Nam.d Auitwnxw,tvxit <br /> Sect=IV ASBESTOS [t3sneratdr epmpleoa a d f g Operaoar compwlea e} <br /> a Operators'Name b Operators Phone No <br /> c Operators Address <br /> d Special Handling instructions and additional Information <br /> tely descri <br /> ed above by <br /> oper <br /> are fu <br /> packed marked anii d labeled 0 d are n all respects ini'';isreoy declareaproperr cothenditional <br /> tionttorlsransponnalent by highwayllaceord ng torapplicable internationall and government gregula'tions and are Gassdie�d <br /> I <br /> Dale.10 <br /> I e Operators NameBTitle Operatorsg4neura <br /> I PnnvrYP* <br /> 1 f Name and Address <br /> Of Responsible Agency <br /> I g ❑ Friable ❑ Non inable ❑ Both 1 triable %nonfriable <br /> Operator raters to ma company wheeh owns leasee:operates controls or Supervises the facility,being demolished or renovated or the demolition or renovation operation or bat <br /> i <br /> © 26o-72ne 5.97 <br /> REORDER ONLY THROUGH BR l UARCO CONTRACT TRANSPORTER RETAIN Nam <br />