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r NON-NAZARAUS SPECIAL WASTE & 3BESTOS MANIFEST <br /> If wa�e is asbestos If waste is NQJ asbestos waste,pcompllete�ete onlyns lSections 1,11 1111 and II and III No. 512286 <br /> o � a-2bENtRAT�3R;�Wf <br /> �ias> . 1_� "�" -"w ,� � n =� <br /> enorator Name ARM PRODUCTS COMPANY b Generating Location ARS STATION 006020 <br /> Address Poo 5077 d Address 1711 E. Y'OSERITE <br /> BUHM PARK# CA WG22-5077 KhMMIM, to <br /> Phone No (925) 299-8891 PAUL SUPPLE I Phone No fi/A <br /> ner of the generating facility differs from the generator,provide <br /> wner's Name ARM PROS GbMBANY h Owner's Phone No SOM " I(Q) <br /> C A 4 0 5 <br /> 101-5 <br /> i30 2 0 3 4 TYPE <br /> FI WASTE GODSContainers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> I= fl"MDOUS "SOILB -BAG <br /> Description of Waste k Ou ntrty Units No TYPE BA -B MIL PLASTIC BAG <br /> or 1 <br /> O 011 <br /> R H 0 1 O -OTHER WRAP <br /> LNERATORS CERTIFICATION I hereby certify 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 property described classified and packaged,and is in proper condition for transportation according to P -POUNDS <br /> pplrcabie regulations AND,ff the waste Is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Y -YARDS <br /> estnctions l certify and warrant that the waste has been treated in accordance with the requirements of 40 CFR Part 266 and is no longer a M' CUBIC METERS <br /> azardous waste as defined by 40 CFR Part 261 at the regrjBa c of ARCM! r t}] PANV Y3 -CUBIC YARDS <br /> 1 + O -OTHER <br /> X=SSA KIRH/ DILLMD 9h'1i`IR01161. 5 d Ic <br /> enerator Authorized Agent Name Signature Shipment Date <br /> "w sr� °r "fTariS COrlt lets e" '--- <br /> 7 <br /> TRANSPORTER °{Generatoricotriplete d,=Trails Q oo h n <br /> ''( TRANSPORTERI �� t TRANSPORTERII <br /> we l�.�til�'►r ` t : h Name <br /> �r' 1f r- <br /> Address >f�' �" �� e- i Address 1 <br /> Driver Name/Title _� '� I Driver Name/Title <br /> `�r� PRINr11YPE PRrNT/TYPE <br /> hone No 1� S e Truck No �' k Phone No i Truck No <br /> I. <br /> Vehicle License No/State �� �a m Vehicle License No/State <br /> nowled erne of Receipt of Matenals / Acknowledgement of Receipt of Matenals <br /> 1 ) L ^ �1 <br /> n <br /> (krver nature <br /> Srmpment Date Driver Signature Stu Date <br /> OCI`III _ $ DESTINATION'[Gsrierator oonnp�etes aadl destination srt�xcomPletes e f y p m'Y <br /> Ke Name <br /> ri _ VASCO ROAD SAN ITAPY 1 ANDP ILL c Phone No (92 5) 44-1 <br /> , <br /> ysical Address <br /> 4 X01 tq. Vmcc ROAD d Marling Address 0X I N. VALC0 IZOAI) <br /> f <br /> ?.: v%PJ-_'0f1E. CA 94550 LIJE71-tOltl , <br /> iscrepancy 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 /> me of Authonzed Agent Signanrre Receipt Date <br /> tIL0111 IV ASBESTOS (Generator complete a-d,f,g,Shipper*completes e) <br /> rs'st Name b Shippers's*Phone No <br /> rs's`Address <br /> hrppers's Special Handling instructions and additional information <br /> iFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified packaged <br /> is ed and tabeledlplacarded and are in all respects in proper condition for transport according to applicable international and national governmental regulations <br />