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NON-HAZARd,US SPECIAL WASTE &(SBEST0S MANIFEST <br /> tt waste is asbestos waste,complete Sections I,It III and IV No. 512285 <br /> Uwaste Is tZ asbestos waste,complete only Sections I.Q and III <br /> A]= PA00[JC 8 fJfWPARY AROD STATICIff #4C,020Generator Name b Generating Location <br /> Address !fes 3077 d Address x711 E. YOSEMITE <br /> ODOR FMIZCA 90622-5077 MA! l`ECA, CA <br /> Phone No <br /> (925) 299-8891 PAUL SUPPLE f Phone No II/A <br /> owner of the generating facility differs from the generator,provide <br /> Owner's Name ARM PRQIW.TS CORPANT h Owner's Phone No sameL6 I(a) <br /> C A 4 0 5 p 5 0 4 9 l3 2 0 3 4 <br /> BFI WASTE CODE Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> HON-HAZARMIM SOIL B -BAG <br /> Description of Waste k Duanti Units No TYPE BA -6 MIL PLASTIC BAG <br /> or <br /> O O 01/ O I T -TRUCK <br /> O -OTHER WRAP <br /> GENERATORS 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 ciassrfied and packaged and is in proper condition for transportation according to P -POUNDS <br /> applicable regulations AND,if the waste Is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Y -YARDS <br /> Restrictions I certify and warrant that the waste has been treat ,in accordance with uirernents x140 CFR Part 268 and is no longer a M' -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261 kt j= r� PROMS Y' -CUBIC YARDS <br /> N=S" IyCnN/ DILL&W S�PLi20l+Zr r` >� r O -OTHER <br /> Generator Authorized Agent Name Signature ! t Shipment Date - <br /> � t-' »r ��=�W���TTanSportBrz�[%013t� ��» �+� ,.� �. °� "; < �1�,q. <br /> ©l�� ANSPDF TER Generator+r rnPtete a cti,�Trans rter ilwp ate r T� C;'-nr »� i a <br /> I <br /> TRANSPORTER I TRANSPORTER II <br />-Name— -'fir n sI ;`J`.)' --<-- = '- h Name - - - <br /> Address 9 A/ )0 T h . i Address <br /> Ps 0) - 05C _ <br /> Driver Name/Title= �fl(e i ( kin ri _) - __ j driver NamelTitla - - _ -- - - <br /> {9 �457 PFWttrYPE PRIN frME — <br /> -Phone No - - — ----e=Truck No k Phone No - -- -- -1 Tnick No - <br /> Vehicle License NoJState r JA � 1 C4 m Vehicle License NoJState <br /> Acknowledgement of Receipt of Materials Acknowledgement of Receipt of Materials <br /> !�f ! �J �y r f r `•..J C>Is 0 � � n <br /> �I <br /> f18hXB D.I. Ilriver rieture �8 <br /> If.AI7OF (525) 447-0491 <br /> Site Name c Phone No <br /> c - : 4001 N. VASCO ROAD <br /> Physical Address d Mailing Address <br /> i - , -� LIVERkIOItL, CA 945bfr <br /> Discrepancy Indication Space <br /> I hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate ' <br /> JoBt 1007/106 <br /> PC# 09-31329 <br /> Name of AutxxUed Agana signature Receipt Mata <br /> s s s � -n r"_ 4"",�a,, s^u 5 is + ps <br /> S13ESTD$K�(GeneratorCaritplete 8-d,1:9,Shipper`zoriW_letes a}� <br /> Shippers's*Name b Shippers's*Phone No <br /> Shippers's*Address 4 <br /> Shippers's Special Handling Instructions and additional information <br /> :RTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified packaged, <br /> irked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations <br />