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. -ARMUS SPECIAL WASTE t&5BESTOS MANIFEST <br /> It waste Is asbestos wad to complete Sections L Il III and IV NO- 907637 <br /> If waste Is tt QI asbestd6 waste complete only Sections I ti and 111 <br /> GENERATOR (Gerierat0rdompaudrs«llaril} <br /> �. EN%jn ;tit li.rT s "-37!18 <br /> E'4<oil Caccia nv U S r>< b Generating Location <br /> Address <br /> - X218 ay � �}� inatton Adarlil d Address +705 "Out,tIV Cbib 91�n1 <br /> Houstotr T% 77.''..'52-2180 -ta ktntt CA <br /> Phone No (7 13) 636-7761 I Phone No 7 <br /> rwner of the generating facility differs from the generator provide <br /> Owner's Name Exxon Company U S A h Owner's Phone No Sante as TIP 1 <br /> TYPE <br /> BFI WASTE CODE A 1 <br /> EI <br /> T) 3 ' Containers LBBAG <br /> ETAL DRUM <br /> LASTIC DRUM <br /> Descnpttnaf ideate Non Tlt3xa2dons Sox1 k Quanb Units No TYPE BA MILLA <br /> oPWRAPSTIC BAG <br /> T RUCK <br /> THER <br /> GENERATOR'S CERTIFICATION I hereby Willy that the above named matenal is not a hazardous waste as defined try 40 CFR Part 261 or UNITS <br /> any applicable slaw law has been property described,classified and packaged and Is in proper condition for transportation aol rOng to P POUNDS <br /> applicable regulakm AND if the waste is a treatment residue of it previously restricted hazardous waste subject to the Land Drsposat Y YARDS <br /> Rest"alone,I Certify and warrant that the waste has been treated in accordance with the requirements of 40 CFR Pert 269 and is no 101190,a the CUBIC CUBIC YARDS <br /> METERS <br /> hazardous waste asdefined by40CFR Part 261 et illi reQuest of EXXOR COP "- O OTHER <br /> ( <br /> srapment Date <br /> Generator Authorized Agent Net- _Off <br /> Tmrdpoderl <br /> TRANSPORTER Gensratorrndlplelae T A tohrt <br /> TRANSPORTER i TRANSPORTER 11 <br /> Name Dillard Trucltiug 10c h Name <br /> ss <br /> Address P O Box 218 1 Addre <br /> B1 rou CA 0451 1 <br /> r <br /> Diner NameTtle I —P4, Cf l Driver NamelTite PRINTrrYPE <br /> 15101 631-6e7;0 PRINTITYPE <br />! e No a Truck No k Phone No I Tnadc No <br /> License NoJState ,��2_ r m Vehicle License NodState <br /> Ac owledgemarTt of Receipt of Materials Acknowledgement of Receipt of Matenais <br /> Driver <br /> SA Dale Omer n}iufe SM 1 Daro <br />$SCUM 111' t}E$TINATION (Generator c«npfetes a-d dm&Mw+sue a0mpfetas wt) <br /> 8pf vasro Rd Landfill 1.17-0401 <br /> a Site Name c Phone No <br /> b Physical Address <br /> 4001 :firth %1stu Road d MailmgAddress )001 North rtaro ROaJ <br /> Llvelaott C\ 415-,0 Tip-iimore t �' 94550 <br /> a 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 /> 3OB9 2002 68 <br /> f �i a ar Au <br /> NaR.ropt01" Pus 09-201,31 <br /> m. unnz.d AW" <br /> Section IV ' ASBESTOS (Ganaratorcanpietae.a.f 4015eratroontptet"41 <br /> a Operators'Name b Operator's Phone No <br /> c. Operators Address <br /> d Special Handling Instructions and additional Information <br /> e try <br /> OPERATORS <br /> marked andrlabe ed and are in all respects in propet the r condi onnten tforltranspconsignment <br /> nby highway llaccording t accuratelyy and described <br /> Inn ernational and governmentgregulationstiand are dassdled <br /> e Operators Name&Title P.laveyP. rorOpsrasSigrsuxa Dau <br /> f Name and Address <br /> of Responsible Agency <br /> g ❑ Friable ❑ Non friable ❑ Both ;friable %nontriable <br /> Orator refers t0 the company which owns leases operates controls or supervises the Iacilay being demolished or renovated or the dernoialon or renovation operation or both <br /> ® 24672065.93 <br /> REORDER ONLY THROUGH BFI r UARCO CONTRACT TRANSPORTER RETAIN <br />