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1621 Brookside Rd, Stockton Record ID PR0513871 <br /> 4/30/2019 <br /> Photo 2: No waste analysis records were available for review for the asbestos waste for manifest 1387267 (8/23/2017). <br /> UREPU6IJC NONHAZARDOUS SPECIAL WASTE&ASBESTOS MANIFEST <br /> sa^ SERVICES <br /> 1387267 If wasra is ashostog we ete.complete sections I.it.II{and Iv <br /> R waste Is NOT asbeslos waste,complete Sections I,it and III <br /> 1. GENERATOR (Generator cum,Ltes la-r) <br /> a.Generator's US EPA ID Number b.Man}fast Document Number c-Page 1 of ow <br /> CISanerator's Name and I-pcation: a.Generators marring Addrew. <br /> SgofX.}p,)VhrFiAeR SCNe�L17►S�'r�t{' t��4`�N�IANI.Ali�4s�oC��'JKCrg432.05 <br /> 44 5+`I av foAe)q952a; <br /> f.Phone: Ziot 915 -)045 g-Phone. Z.3� <br /> If owner of the generating facility differs from the Ge eroWr.provitle: <br /> h.Owners Name: i_Dwnaes Phone No.: <br /> j.Waste FmHle 4 I: Exp.Pete L Waste Shipping Name and M.Containers n.Total o.Una <br /> Dascri tion No. T e Ouand Wflvol <br /> kfN-VA'L, /OuSW.iLe f <br /> >+� �{2o Iy&i I50qo I;i2—ID— 11, 0af4 A;16tLtps61 2 6M �� `l <br /> ,d o � - <br /> 4 <br /> R <br /> r <br /> GENERATOR'S CERTIFICATION, I hereby a-rtify Thal the above named material is not a hazardous waste as deigned by 40 CFR e r or any applicable <br /> state law,has been property descniced.dassi5ad and packaged,and is in proper earditior for transportation according to applicable regulations;AND,Gthis <br /> waste is a treatment residue of a previously rPsfricteI hazardous waste subject to the Land Disposal Restrictions.I certify and xarrant chat the waste has <br /> been treated in accordance with hhe"""em�nts of 4�R 268 and is no longer a nazartlous waste as defined h 4g CFR 281. <br /> CAr7 11m 10 —4— � T.Date <br /> this .Generator Aµt onzetleM Name IPrt_c. __� g.$1 nature <br /> _ 11. TRANSPORTER Generator xmpletes Via-b and Trans orter com letes 11c-e <br /> a.Tranaporter's Name and Address, a t-tk F P hI' ((A A hd,EA Vr Jt44 r"r�AL, <br /> v4(-GAA C 9 M Dol ff, G4 q 9 a.'S <br /> b_Phone: 5 4 37 - -3—1 <br /> 4 y 1, e,Da e <br /> c,Dnver Name Pnn[ <br /> d.si nature <br /> III- DESTINATION (Generator complete 19a-ceaUs D ASNnmblerD ditor co panty lndiicadtim space <br /> E a.Disposal F ckli�d Site Add Gs n.I <br /> Ir y [of m knawled a the for in is W <br /> I h at thea ova amad mataral has b n ecce a <br /> i <br /> Dots <br /> I. I nature tete IVg-i) <br /> a s of uthodzad a Generator compVet Va-f and O p <br /> Iv, ASBESTOS ( e Responsible Agencey Name and Address t�G 6K Z,CLp��AyL <br /> a,Op rators Name and Address: .nnuw�'aG �rcSt+AG l4 83'125 _ <br /> j1jA6lAV1(K CAVI <br /> ray,G�S Grh33 art 1`1t C 43725 d.Plrone: <br /> b.Phone: +Z— <br /> a.Special Handling Instructions and Adtlaiona!Information: <br /> %Non-rdabke h the proper stopping name <br /> 1 %Friable livable international and <br /> f.❑ Friable Nor-Friable Both rd[n to app <br /> lacarded,and are in it respeds in proper condition for transport acro 9 <br /> OpERgTOR'S GERTckt led Oma�rked and aboledlp at Gra coolants of n consignment are sully antl accuratefY descn <br /> and are classi4ad,pa "I rL3,r <br /> Rational ovemmental <br /> re viations. V <br /> D W k - i.Pate <br /> h.SI nature or supervises Gra fedlity being demolished or renovated,or Ma demolition or <br /> .O orators Name end Till. Print RS-F11M <br /> erre <br /> -Operator raters to tha cort'rpapy which owns,keasea,operates.controls, <br /> M renovation a oration or bath <br /> DESTIFrA710N RETURN <br /> REv i2itc <br /> ��r.rco aTnR'S INfI'IpL CCPV <br /> John Alaniz, REHS Page 2 of 5 <br />