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!` NON-HAZARD.-,US SPECIAL WASTE & . 3SESTOS MANIFEST <br /> If waste is asbestos waste,complete Sections I,II,M and IV <br /> If waste is 1�asbestos waste,complete only Sections I,II and III No-512259 <br /> 77 77 <br /> „. ENER�4TOR'(Oenaretor completessec�ora�}, <br /> ARCO PRWAX'T3 COWANY ARCD ST:TIfA OW20 <br /> a Generator Name b Generating Location <br /> c Address PCIB 5077 d Address 1711 I;. YOSU41TE <br /> $UEM PAkK, CA 90622-5077 XxiTWA, CA <br /> e Phone No <br /> (925) 29y f Phone No <br /> —8891 PAUL SMPLk N/A <br /> t owner of the generating facility differs from the generator,provide <br /> ARM PRS AX-fS COMPANY Sam ea I(e) <br /> Owner's Name h Owners Phone No <br /> C II 4 Oa () 5 1 12 9 02 1 OS Q TYPE <br /> BFI WASTE CODE Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> MN—HAZ3IRG M SOIL B -BAG <br /> j Description of Waste k Quant Units No TYPE BA -6 MIL PLASTIC BAG <br /> or n <br /> " 101 <br /> 0 1 m T -TRUCK O -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 Iratad in accordance with thg requirements of 40 CFR Part 268 and is no longer a M' -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261 LI38 tit OS- Ait"Wo PRODUCT' �_V4PV'y Y9 -CUBIC YARDS <br /> PATRICIA DiLLAIXD/ 13LLLARD UN. J + . , ) �— ! � ) ` O -OTHER <br /> Generator Authonzed Agent Name Signature Shipment Date <br /> T=porLer 1CQ Vete e-A rs n a <br /> Generato" ompietea-d;%T CAI]t <br /> TRANSPORTER I TRANSPORTER H <br /> Game '` h Name <br /> _ J , <br /> b Address `�l� t i f_ �_, � � I Address <br /> c Driver Name/T-We _ I Driver Name/Title <br /> PRItiIT/TYPE PRIhrTlrYPE <br /> Phone No a Truck No ,� k Phone No l Truck No <br /> Vehicle License No./State - f r ' : ;�r 7>' m Vehicle License No/State <br /> Acknowledgement of Receipt of Materials Acknowledgement of Receipt of Materials <br /> ry tri r , F, -1 <br /> Driver n <br /> nature Std Date DrKw S niat" <br /> Sivpysem Date <br /> � a �����'��E�t,N���Q� {�'S� ��MCa'�i'a�'�.#s M �w W'*w�,�����^TY3�t�`�. •e�,.;�-'y <br /> - AR ROFTLL (925) 447-04A1 <br /> 4001 WSite Name c Phone No <br /> ' ' 4001 N. VASCO RC.+Ais <br /> b Physical Address d Marling Address LIL 't CA 94tisc <br /> e Discrepancy Indication Space <br /> 1 I hereby carbily that the above named material has been accepted and to the best of my knowledge the foregoing Is true and accuraIe <br /> J08i 1007/107 <br /> f Li P4# 09-31398 <br /> Name aAuttiorized Agern signature,Dete <br /> r <br /> .© i:A� r� ? .k. r 'nr :pperseine b Shfppers's*Phone No <br /> ppers's*Address <br /> d Shippers's Spada]Handling Instructions and additional Information <br /> 1111110 <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 />