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,o-AAZARC.JUS SPECIAL WASTE &,�BESTOS MANIFEST <br /> If waste is asbestos waste complete Sections l 11 111 and IV <br /> it waste is j n asbestos waste complete only Sections t 11 and(H 'N`o' `Q <br /> �'07636 <br /> on I .3 GENERATOR (Gsnaresor oomPletee all of section 1) <br /> a Generator Name ECYnr[ Cuamm'n _ b Generating Location , , 1 ,r 1 - <br /> tziLL <br /> c Address 21807 t"UkN" J tin+t) ,1 1 sn,ie1 <br /> `OL' =."�� d Adds ' 11 <br /> Address )' �, -_ -I <br /> HortstOfi Tl '?" -18r 3tot Nto., , <br /> e Phone No {T f } 65fi-T"B 1 f Phone No + t <br /> I <br /> It owner of the generating facility differs from the generator provide <br /> 1 l <br /> Owners Name E,\u[a „mti't e\ <br /> i g h Owners Phone No <br /> I <br /> i BF1 WASTE CODE + �1 7 t , I 'r TYPE <br /> Ll- DP <br /> DM METAL DRUM <br /> D>' PLAST{C DRUM <br /> Non lire 1I J kil%, ,u r 1 8 BAG <br /> {{ J Description of Waste k Quartz u❑ BA fi MIL r WRAP IC BAG <br /> of WRAP <br /> r) Q HJ <br /> r T TRUCK <br /> O OTHER <br /> GENERATORS CERTIFICATION I hereby certity that the above named material Is nor ahazardous waste as defined by 40 CFR Part 261 or UNITS <br /> any appbcabis state law has been property downbed classified and packaged and}s,n proper condition for transpanation according to P POUNDS <br /> applwabla regulations AND It the wash Is a trestrnsnt residua of a prsv)*"y restricted hazardous waste subject to the Land Olspo4ar Y YARDS <br /> Restrictlans,I certify and warrent that the waste tree been treated m accordance with the requirements of 40 CFR Part 268 and Is ria tartgw a M' CUBIC METERS <br /> hazardwawasteasdeflnedoy4QCFRPart261 It Lht Frtjot>t Of F- ill CU 1 r' '- Y' CUINC YARDS <br /> O OTHER <br /> Generator Aufhonzed Agent Name Signature Sitllmtent Date <br /> Section H' TRAIGSPORTER Generator complete a-d TT S,it mem tie 1�an} <br /> TRANSPORTER[ TRANSPORTER 11 <br /> a Name Iii i lard Trut I I[tg till h Name <br /> j b Address P 1 Itv 4 Lie Address <br /> 13,VOI, t3 -171J <br /> r- DmwthlamwTitle, i T - j Driver NametTliie <br /> t I 116$iil <br /> 1 PR,NMYPE <br /> d Phone NO a Truck No _/__�-,� k Phone NO I Track No <br /> I Vehicle License NoJStats m Vehicle License NbJState <br /> Acknowledgement of Receipt of Materials Acknowledgement of Receipt Of Materials <br /> I <br /> g n <br /> prWer Shipmt Oate Oliver re 1Ohio <br /> Oes-ntiAnON 4GsnsratorcarmWtas.ed.deatlnaHonauamrrlpldts.e-tJ <br /> a Site Name <br /> Bc Phone Ha <br /> P7 Vasco Rd Lalirli 131 f 5113 3 117-13191 <br /> b Physical Address 1001 Kof f h \abc 4 Rua. d Marling Address 1001 North Vas[u Road <br /> GiverluoLe, CA 94155,, -1`=L Will 1 CA X14 i 0 <br /> e plscrepanoy Indication Space <br /> J hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> f �rin 3084 .,Cla 6& <br /> Naina al Aumoazed A Q-g Siptiatun FtecwW aeae E'J it 09-20 <br /> 190 <br /> Seador)IAC ASBESTOS (Generaw carrmjete ad,t g,operagr compleft a 1 <br /> a. Operators Name b Operator's'Phone No <br /> I <br /> } c Operators'Address <br /> d Special Handling tnstruchons and additional Information <br /> OPERATOR'S CERTIFICATION I hereby declare that the contents df this consignmeW are fully and accurately described above by proper shipping name and are classified <br /> packed marked and labeled and are m ail respects in proper crrtdrtOn for Jfansport by highway according to appllCable international and govemmenf regulations <br /> e Operators Name&Title <br /> ! P myrw Opwaws Srgnelufo Dale <br /> I Name and Address <br /> Of i4esporl3ibte Agency <br /> f <br /> g ❑ Fnabte ❑ Non fnaole ❑ Both %friable_ %nonfrtable <br /> Operator refers to the company which owns lease& operates controis or supervises Me facddy,being demolished or renovated or the ctemoetion or rerrovavon operation or both <br /> RECACER ONLY THROUGH BFI f UARCO CONTRACT Q zeo r2ca s'9-` <br /> k TRANSPORTER RETAIN <br />