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NON-HAZARD►..0 `SPECIAL WASTE'& _ 3BESTOS MANIFEST <br /> M <br /> � - <br /> It waste is asbestos waste,complete Sections I,11,Ili and W No <br /> if waste Is NQJ asbestos waste,complete only Sections 1,R and III /�1 <br /> 512267 <br /> a Generator Name PROUOU`�'9 C�lPANI b Generating Location ARM STATION #06020 w <br /> c Address POO 5077 d Address 1711 E. YC+ SMITE <br /> SUMA PARKS CA 905225077 MAMMA, CA <br /> e Phone No (925) 299+$891 PAUL SUPPLE f Phone No RSA <br /> If owner of the generating facility differs from the generator,provide <br /> 9 <br /> Owners Name AM" PRceclu C'S CXMPAW h Owner's Phone No 5ww �� I <br /> C 111 <br /> EM <br /> U 502 D TPE <br /> 1 BFI WASTE CODE Containers DM-METAL DRUM <br /> " <br /> DP -PLASTIC DRUM <br /> NOIN—HA"ARJOUS SOIL B -BAG <br /> I Description of Waste k Quantity Units No TYPE BA -6 MIL.PLASTIC BAG <br /> or 10 101-17 <br /> T -TRUCK WRAP <br /> m O -OTHER <br /> GENERATOR'S CER71FICATION I hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Part 261 or UNIT$ <br /> any applicable state law, has been properly described,classified and packaged, and is in proper condition for transportation according to P -POUNDS <br /> applicable regulations AND,if the waste is a trsatman,Yresidue 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 Mf -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261 a,- the re gimz; t of RROD PROM&= COMPAWY Y' -CUBIC YARDS <br /> P-MUICIA DILTARD/ DILT ARD ElOVr O -OTHER <br /> Generator Authorized Agent Name Signature Shipment Date <br /> Yp P Traria flan <br /> TRANSPOFiTE2—i3 x Ganeretorvomplate Trertsp° Ecom I e-gh n " <br /> TRANSPORTER TRANSPORTERII <br /> Name �� �. I h Name <br /> b Address '>' r r i Address <br /> r <br /> c Driver Name/Tide Driver Namerritle <br /> r PRINTAWE _ <br /> Phone Not f e Truck No PRINT(rYPE <br /> ---ct , <br /> - r i ' { - k Phone No I Truck No <br /> Vehicle License NOJState ` t t m Vehicle License No/State <br /> Acknowledgement of Receipt of Matenals Acknowledgement of Receipt of Materials <br /> ' l <br /> y n <br /> t7dver S Date D�iv�er S nater♦ey,. Shi Det. <br /> y;D'ES` k •i�O �MfyyyndCwrPVY G,�MV, 6i."d'x�� X� �A^fit �A4�Ttfw a'c'ry <br /> VA'SCO ROAD ;P.NXTARy lrj tqD='ILL (925) 447-0492 <br /> Site Namec Phone No _ ,.,r <br /> b Physical Address <br /> e'ool 13, Vmsco ROAD d Matting Address 4002 H. k"AFV= ROAD <br /> ILIVEV.MRE, CA 94.350 LIYItNORE, CA 945!,k, <br /> e Dt=epancy 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 /> f 1PCi# 09-31396 <br /> rhippemt* <br /> orized Agent Spnahue iA, y� Receipt Data <br /> IWIR3a �i i �*S_R 4 R—S �v K fi'Ri,,� "ffiK L �i .`a��'€ ..° ' �.cLF' �"^ ;r-•s , <br /> d-e�T' r <br /> E�� Z <br /> Name b Shlppers's"Phone No <br /> •Address <br /> d Shippers's Special Handling Instructions and additional Information <br /> RTIFICATIOlN I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are claselfied, package, <br /> rked,and labeled/placarded,and are in all respects In proper condition for transport according to applicable international and national governmental regulations <br />