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1621 Brookside Rd, Stockton Record ID PR0513871 <br /> 4/30/2019 <br /> Photo 3: No waste anal sis records were available for review for the asbestos waste for manifest 2843413 8/28/2017 . <br /> Com*REPUBLIC NON-HAZARDOUS SPECIAL WASTE x ASBESTOS MANIFEST <br /> 2843413 if waste I.aahe•los we•te,cani$)Il Seen.-1,II,III and IV <br /> Irwattit le NQj pahwlne.nets,rmmplple eecann•I.II pn<1 til <br /> F• GENERATOR Generator completes la-br)nn <br /> i�AY EPA to Number-- -—_�_--_�]lStl�5�es1 Uoounsni Numhar Ic, sae 1 <br /> d.Generelor'a Name end to boo a lit ll9Sih A.9A!)PPhAftil <br /> ss4"Ihf h sa,ew <br /> -- Ina lumk4id4 Rod 1944 N.1.1 I4nnl I hive <br /> 51�'k�W,,CA W07 YlaGklell.CA 452[15 <br /> r.Phona, �.�O a � r� -_ phone; [2041'!13-71M5%1148 <br /> If owner or 1 0anera na faddhe dmers from the generator,provlda <br /> h.Owner's Noma, 1.Owner's Phone No.; <br /> 1.Waste Proill# T h.E%p.Oele I.Weele Shipping Name an n.Total o.Unit <br /> " <br /> . <br /> . <br /> or lion_ No. Type Qua WWtlI <br /> 4204Y915440 _464"Ill Nun-FriableAshestns <br /> GENERATOR'S CERTIFfGATION: i hereby comfy that the above nern materiel Is not a hazardous waste as defined by 40 CER 281 w any applicable <br /> state law,has been properly described,do I led and packaged,and Is In proper conddlon for Vdnsponadon according to applicable raault the ;AND,K this <br /> waste Is a treatment residue of a prevlously restricted hazardous waste subject to the Lend Disposal Restrictions.I certify and warrant that the.sate hes <br /> been treated In accordance with the re uirements M40 CFR 268 and is no longer a hazardous waste as defined by 40 CFR 281. <br /> 1t <br /> .Generator Authorized Agent Name Print Si nature r.Date <br /> U. TRANSPORTER Generator completes Ill and Transporter completes IC-e) — <br /> a,are enpe eerNeamld and Address: ✓5 �] <br /> 4664 S.C9dw A%ennaQYv" <br /> 1—.1A 93735 <br /> b.Phone: ""'233-7464 <br /> r� <br /> c.Driver Name Print eture e.Data <br /> III. DESTINATION (Generator complete Illa-c and Destination Site completes Illd-g) <br /> a.ElsposgF Fecillry and Site Address: c.US EPA Number d.Discrepancy Indication Space: <br /> ""'rdLondhrl <br /> 9999 Ausfin d <br /> Manlaa.C 36 <br /> 09}962-47911 <br /> b. <br /> I here rtf th ove named matedai has ban 1poCeipiled and to the bes,of my knowled a the foregoing Is true gpd.apWrate. <br /> a. me of too Aliqpt i1orlpt f, n Dat <br /> IU. TOS erato comps I f and O ator co le IVg-iJ <br /> a po erato's Name,end Address: C.Responalble Agency Name end Address: <br /> Bgwen�ngeneenng an i Environmental San Jos4uin Valley U0.1 Air Poll,'Owi Control Di45n4I <br /> 4664 S.Cedar Avenue 4800 Entelprse Wey <br /> Fresno,CA 93725 (559)233-7464 Modcsly,CA 95756 <br /> b.Phone: d.Phone: 4209}557-6400 <br /> e.Special Handling Instructions and Addklonal Informatlom <br /> f.❑ Friable rl Non-Friable D Both %Friable %Non-Fdathe <br /> OPTOR'S CERTIFICATION:I hereby declare that the contents of thiconsignment are fully and accurately describad above by the proper shipping name <br /> ERAs <br /> and are cIessified,packaged,marked and labeledlplacarded,and are in all respects in proper coni lon for transport according to applicable Internallonal and <br /> nations!governmental regulations <br /> 9�_`''��, <br /> .Operator's Name and Title Print h. Ina[ I.data <br /> Operator refers to the company which owns,leases,operates,controls,or supervises the faculty being demolished or renovated,or the demolhlon or <br /> renovation o esti,,or both 1A <br /> REV 01114 DESTINATION RETURN Rs-F51i <br /> John Alal REHS Page 3 of 5 <br />