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NON-HAZARD wUS SPECIAL WASTE & i.-SBESTOS MANIFEST <br /> If waste Is asbestos waste,complete Sections 1,II III and IV N Q.512 2 7 3 <br /> If waste Is NOT asbestos waste,complete only Sections I,11 and III <br /> FGenerator <br /> � "GENERATOR {Generator completesName ARCO PRO UCTE CximpAr4y ARCO S'�A i I(]i s #06071 <br /> b Generating Location <br /> c Address PCs 5077 <br /> d Address 1711 8+ oOSEMIT'r, <br /> ISUEM PAIW, CF. 94522-5077 14ANTEM CA <br /> a Phone No (925) 29-8991 PAUL SUPPLE R/A <br /> f Phone No <br /> owner of the generating facility differs from the generator,provide <br /> Owner's Name ARM PJv)jA C:S C0 6WANY 8e I($) <br /> h Owners Phone No Sam � <br /> I <br /> BFI WASTE CODE C A 4 d 5 0 5 2 9 9 0 2 Q 5 0 TYPE <br /> Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> Description of Waste WX4~UA7JUU01= SOIL 8 -BAG <br /> k Ouantl Units No TYPE BA -6 MIL PLASTIC BAG <br /> or 10-10 <br /> 0 <— N U I T -TRUCK O -OTHER WRAP <br /> GENERATOR'S CERTIFICATION I hereby certify that the above named material is not a hazardous waste <br /> as defined by 40 CFA Part 267 or UNITS <br /> any applicable state law has been property described, classined_and packaged, and is in proper condition for transportation according to P -POUNDS <br /> applicable regulations AND,tf the waste Is a treatment residue of a previously restricted hazardous waste subject to the Land Dtsposal 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 Part 261 4t Lt,Q rOgUegt of AI?M F^1.}MI irl CL A." r'3 -CUBIC YARDS <br /> PATRIC7A MLLARD/ DILLARD ENV. -1. <br /> 44 C1 ky 10 -OTHER <br /> Generator Authorized Agent Name Signature Shipment Date <br /> TRANSPORTER''Generatorcoroplete a-d,a Tporr aim Ito <br /> a _ ' <br /> TRANSPORTER T� <br /> ame TRANSPORTER H� t 1 � r� <br /> I h Name <br /> b Address r Address <br /> r <br /> c Dr _ <br /> iver Name/Title <br /> _ �• .1 i r r w j Driver Name/Title PRINT/7YPE ,� PRINTMePE <br /> Phone No �r' % ( = e Truck No I -� k Phone No ! Truck No <br /> _t <br /> Vehicle License NoJState `� m Vehicle License No/State <br /> Ac"V61edgement of Receipt of Materlais Acknowledgement of Receipt of Maienals <br /> orw n <br /> Shipment Date Dmrernat,re <br /> ©ETIN T1 1 '° Date <br /> .Bt I A9CA RSD 87.t11Ies <br /> TARY LANDFILL (92"-) d�7-04y1 <br /> fite Name c Phone No <br /> tZ <br /> b Physical Address d Mailing Address 4001 W. VA:� Z ROAD <br /> I • G LIVER7r ME, CA 945SO <br /> 3 Discrepancy Indication Space <br /> 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# 1007/107 <br /> rhlppe,s�sw-Address 09-31398 Receipt Date <br /> b Shippers's*Phone No <br /> Shippers's Special Handling Instructions and additional information <br /> tIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified package( <br /> ed,and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations <br />