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r <br /> NON-HAZARL-.SUS SPECIAL WASTE & hBESTOS MANIFEST <br /> If waste is asbestos waste,complete Sections I,II,III and IV NO. I� C!] <br /> If waste is NQZ asbestos waste,complete only Sections 1,II and III L J G <br /> �����°��� �; �Et�IERATORR>�+;lnerator�omp�saulor�seat�}����., <br /> a Generator Name AF4W PPAX)U= L014PA"- b Generating Location Alm STATION ¢0602(. <br /> c Address PM 5077 d Address 1711 s. YaSwm; <br /> BUM PMK, to 90„ 22-5077 ev e, CA <br /> e Phone No (925) 29 -88 -1 PXUL SUPPIX f Phone No N/A <br />'If owner of the generating facility differs from the generator,provide <br /> g Owner's Name AP= PPJ)DUCTS MANY h Owner's Phone No SALIG as I(e) <br /> TYPE <br /> i BFI WASTE CODE C A 0 5 C1 IS 1 1 2 9 A 2 01511 Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> t”-HAZARDOUS SOIL B -BAG <br /> I Description of Waste k Duanti Units No TYPE BA -6 MIL.PLASTIC BAG <br /> or <br /> 0 OT -TRUCK <br /> O -OTHER WRAP <br /> LGENERATOR'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 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 treatment residue""M <br /> previoustx restricted hazardous waste subject to the land Disposal Y -YARDS <br /> Restrictions I certify and warrant that the waste has beep treated in accordance with the requirements of 40 CFR Part 269 and is no longer a M3 -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261 At,It <br /> requer-t of ARCO PR / O -CUBICOTHEYARDS <br /> PATRICIA DILL''+RD/ DILIARD Im / <br /> Generator Authorized Agent Name Signature Shipment data <br /> TRANSPORTER Generatorcom Ietesd Transparterlcampli -g <br /> P , Trans er,D corn <br /> plat:h-n <br /> ` A ii \-\ <br /> TRANSPORTER II <br /> Name t- 1 \ 4- ':_ h Name <br /> b Address 2 LT i Address <br /> 1 � r <br /> c Driver Narne/Title /6, 1 1 Driver Nama/1 die <br /> =.? <br /> E f PRINT/1'YPE <br /> Phone No uck No f k Phone No I Truck No <br /> Vehicle License No/State m Vehicle License No/State <br /> Acknowledge a of Re Ip Matena s Acknowledgement of Receipt of Materials <br /> !f <br /> n <br /> Drtver rahue late brwer nature Ste merit Date <br /> EM 0 <br /> Bn VA= RMD SMXTARY WADFUZ 4 (925) 447-0491 <br /> Site Name c Phone No <br /> 4001 it PAsco ROAD <br /> b Physical Address � d Marling Address 4001 N. VA`'m RQT.O <br /> ILIVARNOM, CA 94550 LIWILO;$, CA 9455%) <br /> eDiscrepancy Indication Space <br /> 1 1 hereby oerti y that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> JOD# 1007/107 <br /> f POO 09-31304 <br /> r <br /> Authwtzed Agent 60-11ue Receipt Date <br /> EST015.,r%'td �ers's*Name b Shtpperss*Phone No <br /> ers's*Address <br /> d Shippers's Special Handling Instructions and addthona]information <br /> RTIFICATION l hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, package; <br /> rked,and labeled/placarded,and are in all respects in proper condition for transport according to applicable International and national governmental regulatioils <br />