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1621 Brookside Rd, Stockton Record ID PR0513871 <br /> 4/30/2019 <br /> Photo 1: No waste analysis records were available for review for the asbestos waste for manifest 3055469 (9/6/2017). <br /> ..Y qa REPUBI <br /> SERVICE! <br /> RBPat78tlC NON—HAZARDOUS SPECIAL WASTE&ASBESTOS MANIFEST :387267 <br /> SERVICES <br /> - L GENERATOR(f <br /> 3055469 te is NOT asbestoasbei ss was a.comSection. <br /> i Seections 1 andIII <br /> a Ga—si uS EPA 1D Nub <br /> I. GENERATOR Generator completes la-id.r�enemtWa rrarea earl <br /> 5 'f.�`TPgUh�FFcd• <br /> Lai1�EPA lb Nurttbar h.Manaea[Document Number c.Page 1 d f q 4 N Qi ora t^ Pr <br /> 3��354b� Arrnrm. i rPrmne. Zit `�73 <br /> d.GernitidaiNWi end Loeatlon' n°{nIiea� wal�Tsln t 1 <br /> a ovarw d the 9i feta <br /> I61_I Dr u uiee Ra 1944 N.EI Find Drive <br /> Steelrm,CA 9520 5lockmn.CA 95705 h.O+ri Name. <br /> L Phone:E3DO)0-roes x 2348 1209)933-7045 x 2348 f-Waste PrABe a <br /> PMne: <br /> If owner of the ganeralinp racitty dili from the generator,provide. <br /> h.Owners Name: E.Oemer's Phone No.: <br /> j-Wada Profile 9 11 Date I.Waste SNppmg Name am m.Comainars n,Total o.Unit <br /> DewarIlWon Nc. Type uardiller WWd <br /> 4204Y915040 06117/18 Nor iabkAsbestos <br /> u <br /> GENER ..1;CERTIFIG <br /> elate law,fua heal prepwll <br /> waste b a eealnwm msdue <br /> been❑sated 411 a— <br /> GENERATORS CERTIFICATION, I hereby cedify that the ahove named material Is nal a hazardous waste as defined by 40 CFR 261 or any applicable srS' f <br /> stale law,has been properly described.classified and packaged,and is in proper condition for transportation according to applicable regulations;ANO,it this V P 'aT�Of <br /> waste is a beaLnent residue of a previously restricted hazardous waste subject tu the Lend Disposal Reetections-I certify and warrant that the waals has g- TRAF1SPdfT <br /> been treated in accordance with the requirements of 40 CFR 268 and is r a hazardous waste as defined 140 OF 261. I a_Tre <br /> At C 's <br /> .Generator Auttladai Agent Name Print Signature r.Date <br /> If. TRANSPORTER Generator L;um fates Ila-b and Transporter oompleti Ili <br /> a.Transpprters!dame and Address. a(c f L <br /> 46643 C d.Avy¢,d Enu,n,,,mmn1 <br /> 4464 S.Cedar Avenue e.Mvar flame!Prim} _ <br /> Frnnn,CA 93725DESTINATI <br /> b-Phone: 15591233-v464 sll9lsposa �£ <br /> F I <br /> c. Mer Nerve Prim d,S'nature a.Dal. <br /> Ill. DESTINATION (Generator complete Illa-o and Destination Site completes Illd-9) the r <br /> 0- �acilily and Site Address: A Number d.Discrepancy Indication Space: <br /> A in ft <br /> M tete,CA 95, bf ufrWnZed! <br /> as>9ax�39e lV, ASBESTt7 <br /> her 1 N med material has bean and to knew! a the7g.1 <br /> rate. tors i amagaw.1e. mamA rized A nt Prinl t S'rDate <br /> IV. ASB STOS(Generator completes IVa-f and ops or complete IVg-i) <br /> ,6�Cre e.SPepa!Handhn9 tn: <br /> a.ggrato�sn Nnc-canrain andrnvsironmenlal c.Responsible Agency Name and Address <br /> g g San Joaquin valley Vni6cd Air Pollution Control pialnct <br /> 4664 5.Cedar Avenue 4900 Eererydse way t.Q friable <br /> Fresno.CA 97725 (559)233-7464 Malmo,CA 95356 - OPERATOR'S CERT <br /> i Phone: d.Phone: (339)557-6•wo and aB ria eared.pa <br /> a.Spi Nandtlng Inshuc6ons and Afldigonal Intorma6on: nate it overrr to <br /> f,❑ Friable 11 Ni Q Belh %Friable %tuon-Friable <br /> O ravers Name r <br /> OPERATOR'S CERTIFICATION:I hereby declare that the contents of Nis cansigrrment ata Wily and accurately described above by the proper shipping nerve _ 'OperaCo''reFars w- <br /> and are cfasslflad,packaged,marked and Iabeledfplamrded,and are in all respects in proper condition for transport according to applicable imemational am ranovatld3 <br /> national govern—lal nerjuli REV lvlb <br /> �/Fl rZ7.Cfi� <br /> raters Name and Title Prim 17T.Smri i.Data <br /> 'OperaWr refers to the company which owns,leases,operates,comrols,or supervises the facility being demolished or renovated,or the demolition W <br /> renovation 'operation or With <br /> EPAFotm 8108 <br /> REV 01114 DESTINATION RETURN RS-EE11A <br /> John Alaniz, REHS Page 1 of 5 <br />