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Ultplqq :ARd_4JS SPECIAL WASTE & (-,;BESTCS MANIFEST <br /> 6, 33 4005 If waste is asbestos waste,complete Sections I.H,III and ry N O. CJ 12 A 9 to <br /> If waste is NOT asbestos waste,complete only Sections L H and III /�1 L V <br /> 77,77y n <br /> TS CXWPAMY b Generating Location mriot; w6on <br /> Address POS 5077 d Address 1711 S. TOSFXITZ <br /> RUF AA PMM* M 90622—*5077 �Ai+TI'l�?►• G <br /> Phone No {925) 29't,-8691 PAUL SUPPLE f Phone No N/A <br /> er of the generating facility differs from the generator,provide <br /> tuner's Name ARM PROS COMPANY h Ownet's Phone No same as I(e) <br /> TYPE <br /> I WASTE CODE C A 4 © 5 O O 9 9 0314 1 1 Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> B -BAG <br />(scription of Waste �lHAZKPJ) l8 50YL+ k Quinti Units No TYPE BA -6 MIL.PLASTIC BAG <br /> or WRAP <br /> 010 1 0 E 0 1 T -TRUCK <br /> �J O -OTHER <br /> RENERATORS CERTIFICATION I hereby certify that the above named matenat is not a hazardous waste as defined by 40 CFR Part 261 or UNITS <br /> any applicable state law has been property descnbed classified and packaged, and is in proper condition for transportation according to P -POUNDS <br /> likable regulations AND,if the waste is a treatment resldue of a previously restricted hazardous waste subject to the Land Disposal Y -YARDS <br /> estnc'ons I certify and warrant 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 /> dons waste as defined by 40 CFR Part 261 SL the t treat of ARio PRMUC'TS COMPANY Y' -CUBIC YARDS <br /> r f / O -OTHER <br /> WZISSA KIRK/ DILLARb teAMRON- 1 / /f ,_''�.-1— O a e1 <br /> JqJ <br /> nerator Authorized Agent Name Signature Shipment Date <br /> - wT enspo completee-9 ` <br /> -'TRANSPORTER (Generatorcoinplete a-dd, Traits rtw comptate!t ill <br /> TRANSPORTER I TRANSPORTER II <br /> be 4- .s , t r h 2 h Name <br /> f } <br /> Address .. - i Address-- <br /> Driver Name/T-rtle ,�. '�`�``r Yl�U.�+ a *t �'' Drner Name/Tttle PRINTnWE <br /> PRINTfrYPE <br /> I tone No i 1 ��#i e Truck No 1 k Phone No I Truck No <br /> Vehicle License No/State � = i m Vehicle License No/State <br /> nowtedgement of Receipt of Materials Acknowledgement of Receipt of Materials <br /> Date I Driver signature Ship mini Date <br /> 3 Ofif kcb: `DE$TWATION'rCet�eiator completesaf; estinatfian i<e+completes efl k ,_ - <br /> F3k'I — VF.SOQ R�;AD SANITARY LANDz TLL (925) 44--0491 <br /> e Name c Phone No <br /> 4 U t ,. y;;wc; 2f iQ 4' 0 h. LSA:C� ROAD <br /> lysical Address d Mailing Address <br /> i.iVlwc�iCs t, rvA �3�5 Li�I".:�.r:Csfi�., 3� 5 <br /> �screpancy Indication Space <br /> ereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> FonIV <br /> Agent signature Receipt Date <br />^ ASBESTOS (Generator complete a-d,f,g,Shipper•completes e) <br /> ame b Shippers's* Phone No <br /> dress <br /> I ippers%Special Handling Instructions and additional information <br /> IFICATIOIV I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified packaged <br /> to ed,and labeled/placarded and are to all respects in proper condition for transport according to applicable international and national governmental regulations <br />