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11 will I I <br /> LONON-HAZf#DOUS SPECIAL WAS"%& ASBESTOS MANIFEST <br /> If waste is asbestos waste,complete Sections 1,H,III and IV.' No. 3 63(.1-2, <br /> If waste is NOT asbestos waste,complete only Sections 1,11 and III. <br /> a. Generator Name: ARC0 PRODUCTS CO PCO # 06080 <br /> b.-Generating Locatio <br /> c. Address:; POB 5077 d: Address: 85 LOUISE AVENUE <br /> BURWA PARK, CA 90622-5077 LPTHROP, CA 06225-077 <br /> e. Phone No.: I. Phone No.: —(925) 299-8@91 <br /> If owner of the generating facility differs from the generator,provide: <br /> g. Owner's Name: FAUL SUPPLE h. Owner's Phone No.: <br /> DM- METAL DRUM <br /> —M [�J� 2 Containers DP - PLASTIC DRUM <br /> TYPE <br /> I. BFI WASTE CODE <br /> B - BAG <br /> j. Description of Waste: N) 14 ZZ .-L-11 L k. Qu Units No. TYPE BA - 6 MIL. PLASTIC BAG <br /> or WRAP <br /> I- -T I i L; i<CTUCK <br /> ! r - ; � . _:.— F. :.. E OTHER <br /> 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 <br /> any applicable state law, has 4en properly described, classified and packaged, and is in proper condition for transportation according to P POUNDS <br /> applicable j/egulati D'if the waste is a treatment residue of a previously restricted hazardous waste supiect to the Land Disposal Y YARDS <br /> ons'" <br /> Reltirptions,I certify and rrint that the waste has been treated in accordance with the requirements of 40 CFR Part 268 and is no longer a M3 CUBIC METERS <br /> ha do swase efin 40 CFR Part 261. y3 <br /> CUBIC YARDS <br /> 0 OTHER <br /> r Au o I <br /> A n ame Signature UEFj§R <br /> Shipment Date <br /> M, <br /> TRph -V <br /> "o rpnspo erjdbrnpleta'e <br /> Qe6 r6to <br /> Rcorn plete:hn. <br /> TRANSPORTERI TRANSPORTERII <br /> a. Name: DILLARD TRI-IcKINs, Tmc h. Name: <br /> b. Addre ss: Y C,x ,,-� '/ -/ i. Address: <br /> 13 <br /> c. Driver Name Title: ./TYPE j. Driver Name/Title: <br /> PRINT PR�NT TYPE <br /> d. Phone No.: ( 925) 034-6a5 Truck No. <br /> . -7, , <br /> 1 k. Phone No.: <br /> �;? <br /> Truck No.: <br /> f. Vehicle License No./State: m.Vehicle License No. State: <br /> Acknqwledge,rnent-Qf Re,,Peipt of.M rials. <br /> Acknowledgement of Receipt of Materials. <br /> Driver,Sfgnat7 <br /> 9. <br /> n. <br /> Shipment M21!2a!2 Driver 2g2a!n Shipment Date <br /> DESTINATION (Generator completes 6-d,destination site cornpletes e-f,) <br /> a. Site Name: BF1 VR c. Phone No.: <br /> b. Physical Address: 4 1)0 1 N. <br /> d. Mailing Address: <br /> LIVERISDRE <br /> e. 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 /> Name of Authorized Agent Signature7 <br /> Receipt Liam <br /> Section IV ASBESTOS (Generator complete a-d,f,g,Operator*completes e.) <br /> a. Operator's Name: b. Operator's*Phone No.: <br /> c. Operator's Address: <br /> d. Special Handling Instructions and additional information: <br /> OPERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and government regulations. <br /> e. Operator's Name&Title: <br />