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r NON-HAZARa. US SPECIAL WASTE & ,_3BESTOS MANIFEST <br /> l <br /> If waste Is asbestos waste,complete Sections I,II,III and IV <br /> If waste is N_QJ asbestos waste,complete only Sections 1,II and III No- 512270 <br /> ERATORa <br /> a Generator Name A= PRO'',UCM COMPAKYr ___' - - _ ARM 0"4 nA ON "C1G02U <br /> b Generating Location <br /> c Address POD 5077 d Address 1721 E. yoSa;lTFI <br /> ---------------------- <br /> PARR, CA 90622-5077 �IAr.���cu, cx <br /> e Phone Na fv 925 2 X9-8"g PMOL SUPPL` f Phone No H/A <br /> It owner of the generating facility differs from the generator,provide <br /> g Owners Name ARCO PROr'AXITS OIKPANY Sate as I(a) <br /> h Owners Phone No <br /> c A a os a5 2 5 tai 050 TYPE <br /> BFI WASTE CODE 1 11 Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> I Description of Waste WM-RA7 RDOUS SOIL B -BAG <br /> k Qu units No TYPE BA -6 MIL PLASTIC BAG <br /> or 1 <br /> 0 <br /> 0 U I a 0 1 m T -TRUCK 0 -OTHER WRAP <br /> GENERATOR'S 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 /> 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 Part 261 at Via x equeist; Of AR(X) PIT, DUCE A c, �lPANY Y3 -CUBIC YARDS <br /> P_;Ml CIA DILI.AisD/ DILLARD ENIV. s � �� ,j O -OTHER <br /> Generator Authorized Agent Name Signature Shipment Date <br /> Se,C �' ' w �; 3 , <br /> fQ[i II` n�A ` TRANSPORTER ' Transporter l coin to a=9 <br /> {Generator f timpiete'a d, ) er II co ate , � M� <br /> h"ri3 �p <br /> TRANSPORTERI^ - TRANSPORTERII <br /> a Name ' N i f r- h Name - - - <br /> b Address _ , / f_ t Address <br /> c Dnver NameMfle '� / - = 7/ = l =c - j Driver Name/title - - - <br /> PRINT/IYPE PRINTMIRE <br /> d Phone No / „r= `� e Truck No <br /> 7'J G -k-Phone No - - -- - - I Truck No <br /> f Vehicle License NoJState r m Vehicle License NoJState <br /> Acknowledgement of Reoeipt�,eo�f Materials Acknowledgement of Receipt of Materials <br /> n <br /> E shi Date Drivers nature <br /> Shlpm=Data <br /> ...t-'^._ v.v.,n, � .3 . R�'•7' e8 i�I .� �-m�`�'..�M+� p 'r3 r n'��.M��n_ �4��eW� .'` �.. <br /> a Site Name <br /> HFI - VA9CD RO?!D SANITARY LAtMl- Ly (925) 447-0491 <br /> c Phone Na <br /> d(YA N. D <br /> b Physical Address 4f301 N, VA.�C'O R(aA[� <br /> d Mailing Address <br /> LIVFRI ZEi Cil 94550LAV-121110RS, CA :4550 <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 /> J'-,H# 1(07/107 <br /> f ---- �- - -004 Dg--31 391, <br /> Nein.w Authorized Ayarrt s,pnewre Receipt oats <br /> N <br /> a Shippers's*Name <br /> b Shippers's*Phone No <br /> c Shippers's*Address <br /> d Shippers's Special Handling Instructions and additional information <br /> CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packs <br /> marked,and labeledlplacarded,and are in all respects in proper condition for transport according to applicable International and national governmental regulations <br />