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SEP-06-19% OB:29 I D: I WM, INC. P.02 <br /> NON-HAZARD SPECIAL WASTE & A&ESTOS MANIFEST' <br /> If w;We is asbestos waste,complete Sections 1.It lit and Iv. Np, 4441 J <br /> If waste is NOT asbestos wage,oonn fete only Sections I,11 and I¢ <br /> Section I _— GENERATOR (Generator oouoetm an of Socu—F) i <br /> Generator Nam.. 4Nest:le, USA, Inc. Port Stockton :•sees <br /> b. Generating Location: <br />-. Address 800 ii 3rand Blvd. d. Address: 4343 FZe ont St <br /> 11an6a1e,. CA 91203 Stockton, CA <br /> Phone No.: 818-549-5948 f. Phone No,: <br /> owner of the generating tarality differs from the generator,provide: <br /> Ownera Name: h, Owners Phone No.: <br /> BFI WASTE CODE a `�" t7 �3 © L9 1 7-1 T'1 & [01 U RS15_CContainers DM-METAL DRUM <br /> DP-PLASTIC OFIUM <br /> Soil cuttings B -SAG <br /> Description of Waste: g k, Quant' tlrtits No. TYPE BA -6 MIL.PLASTIC BAG <br /> cw <br /> 0 -OTHER WRAP <br /> GENERATOR'S CEFITIHCATION: I hereby certify mat the above rwAtl rrotarial is not a nazar sous wasto as donned by 40 CFR Part 261 or UNITS <br /> any applkaale state law, has been property descrtbed, dassif"ied and packaged, and is in proper condition for tranoWar abon a000r&V 10 P -POUNDS <br /> applicable regutetiona;AND,If the waste Is a 6votrnent realdae of a pmviounly restricted hserdewn ersaM subject to tha Land Dlspasal Y -YARDS <br /> Restrictions,I certify and warrant that the waste has been treated In a000rclarrco with the requirements of 40 CRR Part 209 and is no longer a M' -CUSIC METERS <br /> hazardous waste as defined by 40 CFA Part 261, .0 / Y' -CUBIC YARDS <br /> Lr <br /> - y X rrAv pN zw 464L464L7- '0'-Lz '04M - O -OTHER <br /> ?tom^.-• � r,�if �� .�Z�-•...,.�___. <br /> Generator AUthoorifed Agem Name Signature Shlpmont Date <br /> :TTRANSPOKM <br /> TRANSPORTERI TRANSPORTERII <br /> Name: IVM, Inc. h, Name: <br /> Address: 950 Ames Ave. i. Address: <br /> Milpitas, CA 95435 <br /> Driver Namelrttlei; 9)1( q,�Nr7y J. Driver Name/Tkle: <br /> 408-942-899 " �j PiMNTRYPE <br /> Phone No.: s. Truck No.: �// _��! k. Phone No.:N_ _ I_ Truck No.: <br /> Vehicle Koerte NodState: m.Vehicle License NoJState: <br /> Acknowledgement of Receipt of Materials. Acknowledgement of Receipt of Materials. <br /> ` t <br /> t <br /> 1 _ <br /> r <br /> n. <br /> • r <br /> Din <br /> Date <br /> er S core <br /> onus,sr re _ <br />- - BrI-Vasco 510-447-0491 <br /> Site Name; 0. phone NO.: <br /> 4001 11 V&SCO Ra. Same <br /> PrtysiCal Address: 4001 Halling Address <br /> Livernore, CA 94550 <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 /> - J <br /> Name of AAr)r3.0 Aq*6 `�• taUKe mega 9t Dior <br />.action'Nr . ASBESTOS (G.+terator car+w+�a�,t.t ' r+ .cak*tpt e e i <br /> Operstcr's'Name: bYOperator's•Phone No._ <br /> Operator's'Address: -" <br /> Special Handling Instructions and additional information: <br /> &oo t'S CEWhF1CAT0N: 1 hereby declare that the comants of this consignment are fully and accurately described above by proper shipping name and ate ossified, <br />*wd,marked,and labeled,and are in all respects In proper condition for transport by hVmay auaorditlg to applicaole intsmetional Attd govemmom regulations. <br /> TOTAL P.02 <br />