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NON-HAZARMwUS SPECIAL WASTE & "BEST <br /> j OS MANIFEST <br /> If waste is asbestos waste,complete Sections I,II,III and IV NO- 512255 <br /> If waste is� <br /> asbestos waste,complete only Sections I,if and III <br /> .1 <br /> A= AM <br /> Pl�D�UCTC t" P1�' Af`cQ STATION VOti©1l <br /> a Generator Name b Generating Location <br /> c Address PCO 5077 d Address 1711 E. yCSMT`PLr <br /> HOSNIIi PAS, CA 90622-5077 _ aw"3M, ch <br /> e Phone No {935} 290-8891 PAUL SUPPLE f Phone No RSA <br /> If owner of the generating facility drffers from the generator,provide <br /> g Owners Name ARM PRODUCTS Cx*5PLNy h Owner's Phone No SaW aaLS I(e) t <br /> C ]d 4Q5 0 $ 12 9 QZ 05 PE <br /> i BFI WASTE CODE Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> f Description of Waste -i3AZA)X IWS SOILB -BAG <br /> k ou ntrty Ann$ No TYPE BA -6 MIL PLASTIC BAG <br /> or <br /> 0 0 0 0 2 T -TRUCK WRAP <br /> O -OTHER <br /> GENERATOR'S CERTIFICATION I hereby ce"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 properly descnbed 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)n 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 t 0 request Qf ARM � Y3 -CUBIC YARDS <br /> PA'MIC13XLLARD DILLARD O -OTHER <br /> IR <br /> Generator Authorized Agent Name Signature - ShipmeMe <br /> �n <br /> $�iCilElt <br /> „ �fN$P�RTE��Ge srator, mplste <br /> 1 : TRANS .ER r <br /> TRANSPORTER H <br /> a Name y(�r' { ! <br /> 7 R h Name _ <br /> b Address 4 t! _ a <br /> ..- .... i Address <br /> c Driver Name/Title = _- — __ _ _ -T — _ - Driver Name/Title - <br /> `� _ ' PRINTIE MNTf YPE <br /> d Phone No V -e Truck No - — -- -k-Phone No I Track No <br /> f Vehicle License No/State �._ m Vehicle License No/State <br /> Acknowledgement of Receip of Materials Acknowledgement of Receipt of Materials <br /> Shbrimint <br /> n <br /> Date Driver nature Shiorroni Date <br /> 4s w <br /> a. Site Name BFI — 9ASW ROAD S1lt ITARY LmDF'= c Phone No (925} 447-0491 <br /> - <br /> 4001 lQ• V%Xo ROAD <br /> b Physical Address d Mailing Address 4001 H H. Vit ROAD <br /> i CA 94550 LIVUMORZ f Q 94550 <br /> a Discrepancy Indication Space <br /> 1 hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> JON 1007/107 _ <br /> f <br /> Narns or AiAhortred gparp srarra>ure EIE= <br /> PO# 09-3139,8 <br /> RM <br /> a Shippers%*Name <br /> b Shippers's*phone No <br /> C SNpperft*Address <br /> d ShIPP,61`16's Special HandUng Instructions and additional information <br /> CERTIFICATION ,I hereby declare that the contents qj fibs consignment are fully and accurately described above by proper shipping name and are classified, packa <br /> marked,and labeled/placard adI and are Hi X11 respects in proper condition for transport according to applicable international and national governmental regulations <br />