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LI0NOHAZARLAUS SPECIAL WASTE &ARESTOS MANIFEST <br /> If waste is asbestos waste,complete Sections 1,11,111 and IV. <br /> No. 611404 <br /> If waste is NOT asbestos waste,complete only Sections 1,11 and HL <br /> �bfl GeM_ <br /> Generator name:ARCO PRODUCTS COMPANY ARCO STATION #00595 <br /> b. Generating Location: <br /> Address POB 5077 d. Address: 6100 N. HWY 99 <br /> BUENA PARK, CA 90622-5077 STOCK• ON, CA <br /> Phone No.: (925) 299-8891 PAUL SUPPLE N/A <br /> f. Phone No.: <br /> owner of the generating facility differs from the generator,provide: <br /> Owner's Name: ARCO PRODUCTS COMPANY Same as I(e) <br /> In. Owner's Phone No.: <br /> MA FM 1 O 02 25 TYPEBFI WASTE CODE 2 9 Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> B -BAG <br /> Description of Waste: NON-HAZARDOUS SOIL k. quant' units No. TYPE BA -6 MIL PLASTIC BAG <br /> OO or F] M M T -TRUCK <br /> O -OTHER WRAP <br /> GENERATORS CERTIFICATION: 1 hereby certify that the above named mat rial is not a hazardous waste as defined by 40 CFR Pan 261 or UNITS <br /> any applicable state law, has been properly describe .c"ified and pa aged, and is in proper condition for transportation according to p -POUNDS <br /> applicable regulations;AND,N the waste Is a tr ant rest us of a pr ously restricted hazardous waste subject to the Land Disposal Y -YARDS <br /> Restrictions,I certify and warrant that the waste has been V ed" accord <br /> ripewith e,requirements of 40 CFR Pad 266 and is no longer a M -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261. �� (T,2 est f ARCO PRODUCTS COMPANY Y3 -CUBIC YARDS <br /> PATRICIA DILL_-RD-DILLARD l! -% r 1 O -OTHER <br /> Generator Authorized Agent Name Signature Shipment Date <br /> Uf) I TRANSPORTERGeneratorcom lelea`E TransporterTmlt - <br /> "s -" P Trarrs iter It compm lateeeeh-gn <br /> TRANSPORTERI TRANSPORTERII <br /> DILLARD TRUCKING, INC. <br /> Name: h. Name:__ • <br /> PCIB 579 <br /> Address: i. Address: <br /> BYRON, CA 94514 - -- - <br /> Driver Name/HUe:"-- j. Driver Name[Title: - - <br /> 925-634-6850 PRINT/TYPEPRINT/nYPE <br /> Phone No.: e. Truck No.: k. Phone No.: I. Truck No.: <br /> Jehicle License NoJState: JP45'4SCP m.Vehicle License No./State: <br /> 4cknowledgement of Receipt of Materials. Acknowledgement of Receipt of Materials. <br /> Idwr SnatureShi merit Date Driver Si reture <br /> g _ Shi mens Date <br /> 't•,U n flit DESTINATION (Generator completes ad,tlesilnation she completes a-f) <br /> Site Name: <br /> BFI — VASCO ROAD SANITARY LANDFILL (925) 447-0491 <br /> C. Phone No.: <br /> 'hysical Address: <br /> 4001 N. VASCO ROAD d. Mailing Address 4001 N. VASCO ROAD <br /> i <br /> LIVERMORE, CA 94550 LIVERMORE, CA 94550 <br /> hscrepancy indication Space: <br /> hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate. <br /> !' JOB# 1007-128 <br /> " � PO# 09-31515 <br /> WWOI Aulhoraed Ment SignatureEll Receipt Date f <br /> tiODIV r" ASBESTOSGeneratorcom complete a-d. Shipper-( P 9• . PpeP.completes e.) i <br /> I' <br /> hippers's•Name: b. Shippers's•Phone No.: <br /> hippers's•Address: ; <br /> i <br /> hippers`s Special Handling Instructions and additional information: <br /> TIFICATION: I hereby declare that the contents of this consignment are fully aM e0o.1 dy described above <br /> ed,and labeled/placarded,and are in all respects in byproperfo sfsPPin9 name and are classified, packaged, <br /> proper condition for tnarlenOnt acmrdino to anNiraN<intnrr>�tinnal e.,d.,ri­j..........._.,....,.,-__..,�:___ <br />