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i r• <br /> NON-HAZARD..oUS SPECIAL WASTE & __3BESTOS MANIFEST <br /> M <br /> T <br /> If waste is asbestos waste,complete Sections I,H,111 and IV NO- 512272 O r 5122 7 2 <br /> If waste is NM asbestos waste,complete only Sections I II and III 1�1 G <br /> norator completes allof S Uaa ii .'- <br /> a Generator Name ARCO PRODUCTS CO-NPARY b Generating Location ARM STATION #0602Ci <br /> c Address POB 5077 d Address 1712 R. YOSii RM <br />' BIJEM PARC, CA 90622-5C77 yum"Erh. CA <br /> e Phone No (925) 299—BSgI P''TJL SUPPLE f Phone No N/A <br />,If owner of the generating facility differs from the generator,provide <br /> g Owners Name ARCD PRCOUCTS Cr"WAlgy h Owners Phone No Sann �� 18 <br /> TYPE <br /> BFI WASTE CODE C !1 0 5 0 IS I 1 2 �__j 7 11 0 2 1 O IS Containers DM-METAL ARUM <br /> DP -PLASTIC DRUM <br /> NON—FtA2ARS SAIL B -BAG <br /> ! Description of Waste k QU ntity Units No TYPE BA -6 MIL PLASTIC BAG <br /> or WRAP <br /> 0 0 1 Y O 1 mT -TRUCK <br /> I O -OTHER <br /> GENERATOMS CF_FmFICATION I hereby oertdy 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 /> 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 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 Pan 261 at the requo-t\af ARM vwDUr'TS CCr pANY Y3 -CUBIC YARDS <br /> PATRICIA DIL*I ARD/ DILLARD r—NV. E ' O -OTHER I �/ % r1 <br /> Generator Authorized Agent Name Signature Shipment Date <br /> TRANSPORTER Generator complete a d Tr:.,, °�a n?I�� � <br /> TRANSPORTERI TRANSPORTERII <br /> tame t i f "I ' r ` h Name <br /> b Address ' �` !� ffi .' `! r I . I Address <br /> l <br /> c Driver Name/TTrde Driver Name/Title <br /> PRINTn YPE PRINTfrYPE <br /> Phone No a Truck No r7„r k Phone No I Truck No <br /> Vehicle License NoJState m Vehicle License NoJState <br /> Acknowledgement of Receipt of Matenals Acknowledgement of Receipt of Materials <br /> Driver Skinan SO Date IMver s nature Sli Date <br /> BFI VMW RORD SANITARY LANDFILL r {925) 447-0491 <br /> Site Name c Phone No <br /> 40AL N. VASCO RUD 4001 N. VAsa) RCiAD <br /> Physical Address d Mailing Address <br /> xIv , CA 44550 LIVERMORE, CA 94550 <br /> e 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 /> JOB# 1007j,107 <br /> f PO# 05-313'.,G <br /> Meme dAuthorized Agent Signature Receipt Date <br /> � ��a�� ���, �� ASBE�TAS �tarato�$o�siptei'p a=rs:`���;°������ �.� ;���������r��• �,�� �~ F� .=�,” , <br /> hippers%*Name b Shippers's*Phone No <br /> Shippers's*Addie <br /> d Shippers's Special Handling Instructions and additional information <br /> R71FICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packager <br /> rked,and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations <br />