FIELD DOCUMENTS_FILE 2 - Laserfiche WebLink

Home Browse Search

.. \> 0& fi REPUBLIC fiasco Road Landfill b� tl SERVICESa INC. NON-HAZARDOUS WASTE MANIFEST GENERATOR INFORMATION a)ST)MER/BILL NG INFORMATION Generator Name: Exxon Mobil Refinery&Supply Billing Name: Dillard Environmental Services Address: 3700 W. 190th Street TPT-2 Address: P.O. Box 579 Cry: Torrance County: Los Angeles City: Byron County: Contra Costa State: CA Zip: 90504 State: G4 Zip: 94514 Site Location: Republic Services Description of e Expiration Container Approval Number Waste or Weig t Date Type 1003628 1 Soil/ Drums1 Drum 5/20/2007 Dis ons Follow Drum Labelling Di actions:Generator name,SWIC#,Contents,Date I ocation:Exxon 7-3942 4444 N Pershng Ave Stockton,CA The above Disposal Instructions are a requirement of Republic services,Inc.,for management of the profiled material.The approval Is based upon a review of information provided by the generator and Is contingent upon the receipt at the disposal facility of a waste material essentially equivalent In chemical and physical characteristics and properties to that profiled. I hereby certify that the above described materials are non-hazardous wastes as defined by 40 CFR 261 or any applicable state law.Further,that the above named materials are properly classified,described,packaged,marked,and labeled,ad are in proper condition for transportation according to the ap cable regulations of Department of Tran i7wo .�a�/G.pr..)ba Generator/Authorized Agent Name signature Date Shipped TRANSPORTERINFORMATION Transporter Name: f)i116rd GWIL�L>Y Xigrr,SOT Number. Address: (amn Okabla /2d Truck Number: / s n qgS7cf Phone Number: QaT-&-:3 q-&Si;p I certify no hazardous waste or other regulated substance was knowingly In cod to the waste while in my custody. The waste tronspotod in this vehicle is the waste identified above,to the best of my knowledge. Na�nn a of Authorize gent Signature Date Delivered DISPOSAL SITE INFORMATION Site Name: Vasco Road Phone Number: (925)447-0491 Address: 4001 North Vasco Road Fax Number: (925)447-0499 Livermore,CA 94550 1 hereby acknowledge receipt of the above described materials Name(Print or Type) Signatu Date Received i- D � � `�OVV R 2nes IJ