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1 <br /> l <br /> NON-NAZAR"US SPECIAL WASTE & ._3BESTOS MANIFEST <br /> If waste Is asbestos waste,complete Sections I,II,III and IV w' <br /> � <br /> If waste is h-M asbestos waste,complete only Sections I,II and III N 0.612 2 6 9 <br /> emd <br /> .,�' y� 5� <br /> M!��� <br /> a Generator Name ARCD pROWM Ci]111"i ARfSI S'YATION .l602C <br /> b Generating Location <br /> c Address P0S 5077 8L3r1T'1? <br /> d Address 1711 E. Y0 <br /> B[)r3�i1 P;IRK. Ch 90622-5077 t3At Ell to <br /> E <br /> e Phone No i925) 299 `8891 FAUL SUPPLE NSA <br /> l f Phone No <br /> If owner of the generating facility ditfers from the generator,provide <br /> I g Owner's Name ARM QROnUll COMPAtIFY Sastre ax I{e) <br /> i h Owner's Phone No <br /> I BFI WASTE CODE C 4 G 5 d 5 1 2 9 u (i .i'a r N TYPE <br /> Containers DM-METAL DRUM <br /> 60N-HAZARDOUS SOIL DP -PLASTIC DRUM <br /> B -BAG <br /> 1 Description of Wastek MTE <br /> Units No TYPE BA -6 MIL PLASTIC BAG <br /> Cs 1 m IT <br /> TRUCor K WRAP <br /> GENERATORS CERTIFICATION I hereby certify that the above named material is not a hazardous waste as defined by 4o CFR Part 261 or O OTHER <br /> any applicable state law has been property descnbed,classified and packaged, and is in PrUNIT <br /> oper <br /> applicable regulations <br /> AND,M the waste Is a treatmgnt residue of a previously restricted haxordous wraon for Irantporhetion a c rdi self P -POUNDS <br /> Restrictions,1 call and warrant that the waste has been treated m accordance with the requirements of 4o CFR Part subject t and is no longer a Y -YARDS <br /> hazardous waste as defined by 40 CFR Part 261 9 M' -CUBIC METERS <br /> at the re�l ot_ARCA �'f2nDUCTS C(Y�i"I'AtiY a <br /> Y -CUBIC YARDS <br /> PATRICIA DILLAW;!,p D=LJ,R13 Lill � O -OTHER <br /> Generator Authorized Agent Name Signature - r� * # ---A <br /> SBC�I�t g Shipment Date <br /> �� `�: °��� '��� TRA�NSPORTE ���'�� <br /> TFtANSPORTERI R cenerorc�orr,pieaa-a„� ,ar�s azco ' x �4� ;u� ` <br /> EV” <br /> a <br /> -i RANSPORTEi�II <br /> b _ �^�r �,' ( � lillI Address <br /> c Driver Name/7-Me <br /> PRirrrmPe I Driver NameMtle <br /> d Phone No <br /> a=Truck No �,�� k--Phone No � - - - -- __ <br /> PRINT/rVPE <br /> -� <br /> f Vehicle License No/State �- f�'�" / ! Truck No <br /> Acknowledgement of Receipt of Ma#erlals m Vehicle License Noll JState <br /> Acknowledgement of Receipt of Materials <br /> g 'r��ne — n <br /> �r+ver Sil <br /> sN Date ; ; I ::ortwer s n�a,re <br /> lien <br /> !INJR <br /> Ili <br /> a SrteName SFI VSO Rip SAigITARy LANDFILL <br /> c Phone No 925 4�7-p49'j <br /> b Physical Address 4001 Ill VASCO ROAD v 4001 t4. YAf� ROAD <br /> � . Ch 94550 d Mailing Address <br /> LIVIMMINEe CA 9455- <br /> e Discrepancy Indication Space V <br /> I hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurat <br />- - - JOSW 10t)7/107 <br /> f <br /> risme dAWwAted n�er7[ see pow 1119-31398 <br /> _ Receipt=0�' <br /> -11, 4"lQVP1A&R173 <br /> IP p 3 "' � �� <br /> ti -� � SOS�r{Ganerator cow &`f.� Sipei* :u .�+#� -� <br /> a. Shipperill Name s 4 <br /> b Shippersi Phone No <br /> c Shippers's•Address <br /> d Shippersi Special Handling Instructions and additional Information <br /> CERTIFICATION I hereby declare that thecontents of this consignment are fully and accurately described above by proper shipping name and are classified, packs <br /> marked,and labeledlplacarded,and are In ail respects in proper condition for transport according to applicable international and national governmental regulations <br />