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NON-HAZARDOUS SPECIAL WASTE & <br /> HAZARDASBESTOS MANIFEST <br /> If waste is asbestos waste,complete Sections I,H.Ifl and IV <br /> If waste Is N_Q_T asbestos waste,complete only Sections I,11 and III NO-- 51 2 2 5 H <br /> W " ° w �� 1iGNE�TO�'lcza,� �� x�°Ysi" '�.�' `x.` rel yea �, w as• <br /> (GerleratOf CC�rn�tBiQ8 i*Il'tlf Ori ,,'� •tii� �� �� , <br /> a Generator Name ARW >PRO17MV3 CONPA" A= BTATIO(t a602J~N <br /> b Generating Location <br /> c Address P(8 5077 d Address i '11 $. YOSEMITE88111 PARK, CA 906:'2-5077 MN>1TEf'A, CA <br /> e Phone No (925) 299-8891 PAUL SQppLE !F/A <br /> f Phone No <br /> If owner of the generating facility differs from the generator,provide <br /> Q Owner's Name AIRS PSKK)M '8 COMPARY tsa>i'tse as I(®) <br /> h Owner's Phone Ho <br /> 1 BFI WASTE CODETYP <br /> C A 0 5 <br /> MEEff <br /> O .� f3 S `.} E <br /> Containers DM-METAL DRUM <br /> MON—AR7.'es3�tOWS SOIL B -PLASTIC DRUM <br /> J Description of Waste k Quante Units No TYPE 8A -6 MIL PLASTIC BAG <br /> 0 0 ID <br /> m WRAP <br /> Y 0 2 T T -TRUCK <br /> GENERATORS CERTIFICATION herebyO -OTHER <br /> oe"that the above named material is not a hazardous waste as defined by 40 CFR Part 261 or LJNI <br /> any applicable state law, has been property described, classified and packaged, and is in proper condition for transportation according to I 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 /> hazardousRestrictions,1 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 r <br /> hazardous waste as defined by 40 CFR Part 261 Eli t:� = St p f -ARM p �.s Gti7![FAtPY, <br /> Y3 CUBIC YARDS <br /> PAMICIA Dom/ DILLARD &4V. 14 ri O -OTHER <br /> Generator Authorized Agent Name SEE <br /> ignature <br /> Shipment Date <br /> b a O `RANSPRTts h n°eIbom e <br /> TRANSPORTER I- <br /> TRANSPORTERII <br /> a Name_ d�.�� � S=r�•"c!� <br /> �rjf� h Name , <br /> b Address r f <br /> I Address <br /> 1WON <br /> J-1 <br /> FF r <br /> c-Driver Name/Title -1-910 s or!i' -/� <br /> PRlNT/TYPE T 1 Driver Name/Title <br /> d Phone No ' —e Truck No _ — —� _ PRINTRYPE <br /> �� =15 k Phone No— I Truck No <br /> f Vehicle License No/State [.t! 7 _m Vehicle License No./State <br /> Acknowiedgernent of Receipt of Materials -X - <br /> AcknoWedgernent of Receipt of Matenals <br /> �te triver <br /> o sh' <br /> . _ r Date <br /> VAZ#W MIAD sMITARY LADrrLta. Site Name <br /> ; <br /> (925) 447-0491 <br /> 4L01Sea X= - c Phone No <br /> b Physical Address 40W_14. VASCO RO;-tyj <br /> wm* I.IVr$ S� CA 94 <br /> y 550 d Mailing Address <br /> GA 9450 <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 i g is true and axurae <br /> JCIs13 1007/107 <br /> f <br /> MINIM°f ,�` swnawre POO 09-31398 <br /> 77717:,P <br /> .,.'', Ir <br /> .� Receipt Date <br /> a. Shlppers's*Name <br /> b Shippers's*Phone No <br /> C Shippers's*Address <br /> d Shippers%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, packag <br /> marked,and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations <br />