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r <br /> NON-HAZARL,•�US SPECIAL WASTE 8c SBESTOS MANIFEST <br /> if waste is asbestos waste,complete Sections I,Il,III and IV <br /> If waste is (M J asbestos waste,complete only 512263 <br /> 111;­­l­­ <br /> p y Sections I II and[II �• <br /> s <br /> m r � x,_3 <br /> � ior� '" a pais 7" "� 11711, A <br /> a Generator Name ARM PROMMS COMPARNWY 3TAT2 <br /> LARCOt�W #06020f b Generating Location AR <br /> c Address FM 5077 <br /> d Address 1711. 8. YOSEMITE <br /> BQSM PARXr CA 946225077 M"7+.Ai M <br /> e Phone No (925) 29 —8891 PAOL SUPPLE K/A <br /> f Phone No <br /> If owner of the generating facility differs from the generator,provide <br /> g Owner's Name Ate) MANY SamB as I I <br /> h Owners Phone No <br /> i BFI WASTE CODE C A 4 0 5 4 5 12 9 0 2 O S O LY E <br /> Containers DM-METAL DRUM <br /> NQH—BASF3i []g 8011, DP -PLASTIC DRUM <br /> I Description of Waste k Quaril units NoTYPE BA -BG <br /> PLASTIC BAG <br /> 0 O O i m K WRAP <br /> T -TRUCK <br /> GENERATOR'$CERTIFICATION I hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Part 261 or O -OTHER <br /> any applicable state law, has been property described, classified and packagedion accordingon IT <br /> applicable regulations AND,If the waste Is a treatment residue of a previously restricted h raze dous wastefsubject ttransto hetrLand D Disposal Y YARDS <br /> -POUNDS <br /> Restrictions I certify and warrant that the waste has been fiest�ae¢¢in accordance with th2 requirements of 40 CFR Part 268 and is no longer a M' -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261 8>t Che r�t�g� C� hR>v�C1 r•��n�r-�s cGr�p�,,,�Y a <br /> PJLTRICIA DILLA11W DILLARU LWV, Y CUBIC YARDS <br /> O -OTHER <br /> Generator Auhonzed Agent Name Signature <br /> 5hrpment Date <br /> L <br /> Section II <br /> `TRM ORTER G - TranBporter7 com lata r> W r <br /> enerator complus air. Traria ne�tl complete ate 1i-n <br /> TRANSPORTER <br /> TRANSPORTER II <br /> a Name � ti � _ � - <br /> h Name <br /> b Address <br /> I Address <br /> c DriverNamell-rde <br /> NT I Driver Name/Tift _ <br /> d Phone No T ' [ e Truck No t`—5" — -t'RINTnWE- - —- <br /> _ �'_ k`Phone No — I Truck No <br /> f Vehicle License No/State -" ll m Vehicle License No./State <br /> Acknowledgement of R tpf o Materials Acknowledgement of Receipt of Matenals <br /> - f n <br /> shl Date Driver ftnerture <br /> Y ori Date <br /> 41 il'! 14s. <br /> ��tame ; ARY LANUBILL - t9251 447-0491c Phone No __ <br /> b Physical Address 400 C. VABCO p�D <br /> d Marling Address <br /> LiVFtdIC3ii>G� CA 9455!) <br /> e Discrepancy Indication Space <br /> I hereby Certify that he above named material has been accepted and to the best of my knowledge the foregoing is true and accur <br /> We <br /> J�BO 1007/107 <br /> f <br /> Name at Ai lfmrlte4 A9ertt POS 09-31 a" <br /> Receipt Date <br /> M iis <br /> a Shippers's*Name " <br /> b Shlppers's'Phone No <br /> c Shippers ■Address ' <br /> d Shippers's Spell handling instructions and additional information <br /> CERTIFICATlO✓N 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 labeled/placarded,and are in all respects In proper condition for transport according to applicable International and national governmental regulations <br />