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NON-HAZARIZWS SPECIAL WASTE & :;ESTO, 1(�I� If waste is asbestos waste,complete Sections 1,11,III and IV. NO C) C If waste is NOT asbestos waste,complete only Sections 1,H and M. Generator Name:ARCO PRODUCTS COMPANY b. Generating Location: ARCO STATION # Address POB 5077 d. Address: 6100 N. HWY 99 BUENA PARK, CA 90622-5077 STOCKTON, CA Phone No.: (925) 299-8891 PAUL SUPPLE I. Phone No.: N/A owner of the generating facility differs from the generator,provide: Owner's Name: ARCO PRODUCTS COMPANY h. Owner's Phone No.: Same as I(e) TYPE BFI WASTE CODE MA 0 5 0 2 0 J 9 1 0 2 1 2 5 Containers DM-METAL DRUM DP -PLASTIC DRUM B -SAG Description of Waste: NON—HAZARDOUS SOIL k. 0 ant 0 MO -OTHER SUnits No. TYPE BA -6 MIL TP BAG M or T -TRUCK GENERATOR'S CERTIFICATION: I hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Part 261 or UNITS any applicable state law, has been properly described, classified and packaged, and is in proper condition for transportation according to P -POUNDS applicable regulations;AND,If the waste Is a treatment residuel,f a previously restricted hazardous waste subject to the Land Disposal Y -YARDS Restrictions,I certify and warrant that the waste haobten V ad i accdrdanpe with the requirements of 40 CFR Part 266 and is no longer a M' -CUBIC METERS dou este as d finby 40 CFR Pan 261. ` / Ya -CUBIC YARDS l2re st of ARCO P�P. O -OTHER MFT T W11 DILLARD 't- Generator Authorized Agent Name Signature Shipment Date TRANSPORTER (Generator co' 14rraansorrtte�Il ocmN a hn TRANSPORTERI TRANSPORTERII DILLP.RD TRUCKING, INC. Name: h. Name: Address: POB 579 i. Address: BYRONN, C-A 94514 Driver Name/Me:y�g 1\ I, 0,2- lib OX J. Driver NamefTitle: PRINr/nYPE i— PRINgnYPE 925-634-6850 Phone No.: e. Truck No.r.. ' ' k. Phone No.: I. Track No.: I, Vehicle License No./State: �� Y I m.Vehicle License No./State: Acknowledgeant of ice ipPpf,Materials. ` Acknowledgement of Receipt of Materials. n. dhed5' nature C' Shi meM Date Driver Signature Shl ment Date e�tltin 7II . DESTINATION (Generator completes a d,destination site completes a-f.) Site Name: BFI — V,.SCO ROAD SANITARY LANDFILL c. Phone No.: (925) 447-0491 Physical Address: 4001 N. VASCO ROAD _ d. Mailing Address 4001 N. VASCO ROAD ! LIVERMORE, CA 94550 LIVRt40RE, CA 94550 Discrepancy Indication Space: I. I hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate. j JOB# 1007-128 L j r Nartte PO$ 09-31 ST$ of Authoni Agent Signature Receipt Date on ASBESTOS (Generator complete a-d,t,g,Shipper-completes e. ShippeWs`Name: b. Shippers's•Phone No.: Shippers's`Address: Shippers's Special Handling Instructions and additional information: --.RTIFICATION: I hereby declare that the cements of this consignment are fully and accurately described above by proper shipping name and are classed, packaged, deed,and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national go„emntenfal regulations.