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i NQN-HAZARe JUS SPECIAL WASTE &(—SBESTOS MANIFEST r 1 <br /> 1 <br /> If waste is asbestos waste,complete Sections 1,11,m and IV N w,O 512287 5 A^ <br /> AIf w�rex-ya�{ste is�y asbestos waste,complete only SeIII Sections 1,II and • c L <br /> t Generator Name AID PRODUCT'S COMPANY 4 b Generating Location ARUD SThTYON #06020 <br /> Address Pion 53" 7 d Address 1711 t. YOSEMITE <br /> BL]$tiU1 PPJM, Q 90622-5017 taitTIK26 G <br /> Phone No (925) 299-6891 PAM SUPlPIX f Phone No H/A <br /> f owner of the generating facility differs from the generator, provide <br /> f Owner's Name ARCO PRET)=S CC+!PAXYSa as I(e) <br /> h Owner's Phone ND <br /> TYPE <br /> 9 <br /> BFI WASTE CODE $ 0 5 fl '� 1112 Q 3 - Containers DM-ME=TAL DRUM <br /> DP -PLASTIC DRUM ' <br /> NON-HAYARDGU7iS SAIL B -BAG <br /> Description et Waste k Ouanti Units No TYPE BA -6 MIL PLASTIC BAG <br /> or <br /> 0 <br /> 11,0 <br /> 0II/ Lrl <br /> Q l T -TRUCK WRAP <br /> O -OTHER <br /> GENERATOR'S CERTIFICATION I hereby certrfy 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 been properly described classified and packaged and is in proper condition for transportation according to P -POUNDS <br /> appircable regulations AND,If the waste is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Y -YARDS J <br /> Restrictions,1 certify and warrant that the waste has been treated in accordance with the requirements of 40 CFR Part 268 and is no longer a M' -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261 at it;111@ requent of -MWO PRO-AJC`PS OXWAUY Y3 -CUBIC YARDS <br /> r 1 O -OTHER <br /> NMI BSA 1CIItfY/ t)xLI.11RD �Raa. f ;S_" /; A -�..� <br /> _ Generator Authorized Agent Name Signatute Shipment Data <br /> TRANSPORTERI TRANSPORTER]d <br /> i Name - _ _ _1 / /`� ( _ r r — h Name <br /> Address :t i C� �L i Address <br /> Driver Narie/Title _r —_ E-J j Dirtier Name/Title <br /> PRiNT(rWE Pt wfryPE <br /> I Phone No ` f _e -Truck No — - k-Phone No - - —- -- - I Truck No <br /> Vehicle License No State 1-fK` "'i, j"/n <br /> m Vehicle License NoJState <br /> Acknowle fdgement of Receipt o Vatenals Acknowledgement of Receipt of Matenals <br /> G"ver ftnftr° s pate rimer S shi Date <br /> s <br /> 3ection� WV, r <br /> _ 1 „�� OESTIN_A?IO�il�oer ato�+>d e:;a d, co <br /> _. BFI — VSO Rl"Af) as11NT,11,N tY T.1%t•1DFILL (925) 447-0491 <br /> i Site Name c Phone No <br /> 4,03L I1. V k5C'i itOAD 4f.)01 V. VA Safi ROa s3 <br /> i Physical Address d Mailing Address <br /> L1VM40i`.>i.:, C.? 9455=.) L1V%Rri0R,, CA g=_ <br /> Discrepancy Indication Space <br /> I hereby certity that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate ' <br /> JOB? i0l, 7/1(16 <br /> T^ice <br /> 9—313 <br /> Name of Autlwrrzed AgentSignature Receipt Date <br /> 5L'G1101I IV' 4 AS BEST69"(Generator complete a-d,f,g;Shipper•completes e) <br /> i Shippers's*Name b Shippers's* Phone No <br /> Shippers's*Address <br /> I Shippers's Special Handling Instructions and additional information <br /> ERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified package <br /> f� <br /> Larked,and labeled/placarded and are in all respects in proper condition for transport according to applicable international and national governmental regulations <br />