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NON-HAZARa...US SPECIAL WASTE & , _3BESTOS MANIFEST <br /> It waste rs asbestos waste,complete Sections I,II,III and IV r <br /> If waste Is NQJ asbestos waste,complete only Sections 1,li and III NO. 512274 <br /> GENERAT�OR,��c �aia' r; <br /> les " <br /> p es 8t1 1 <br /> a Generator Name ARCD PRODUCIi'$ Cay - ARM STAT'10ti 006020 <br /> Location <br /> c Address PCs 5077 b Generating1711 Eo YOS&%1TE <br /> d Address <br /> BIJIM PARK* CA 90622-5077 t4U"r-,(;A, CA <br /> e Phone No (925) 29 -8b91 PAUL SUPPLE.' N/A <br /> f Phone Na <br /> If owner of the generating facility differs from the generator,provide <br /> g Owners Name RR00 M MUCTS C)&%`AtdY <br /> In Owners Phone No Sam as I f R) <br /> i BFI WASTE CODEC A 4 O s 0 5 12 9 g !1= TYPE <br /> Containers DM-METAL DRUM , <br /> AJ(]E.'-�HAARf!Ot3S SC}IL DP -PLASTIC DRUM <br /> I Description of Waste k ro, <br /> units No TYPE BA 6 MIL PLASTIC BAG <br /> 0 q Y m or WRAP <br /> 1 T TRUCK <br /> O -OTHER <br /> GENERATORS CERTIFICATION I hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Part 261 or UNIT <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 <br /> Restrictions,I certify and warrant that the waste has been treated in accordance with the re9unY YARDS <br /> ements of 40 CFR Part 268 and is no longer a M' -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261 "- f xiLlBgt �vf eF,CO pq ,� 5 +fig aiiY a <br /> PAxRICIA D1LT.kRD/ -ILLARD ZNV. Y CUBIC YARDS <br /> � � O -OTHER <br /> Generator Authorized Agent Name Signature ! <br /> g Shipment Date <br /> Sa <br /> ��` � ��rnr « TRANSPORTER <br /> -;(Generator com i 'T�f'° complete <br /> P ate a,d-Trans er Q com te <br /> T"A SPORTER I TRANSPORTER I1 <br /> a Name <br /> — - (, h-Name - <br /> b Address <br /> / I Address <br /> C Driver Name/T-itle = --- - _ ir,.�/� <br /> PRINTf"E I Driver Name/Title <br /> d Phone No -.e-Truck No -� - - - --- - — -- _ MNT-aYPE ,---- <br /> �-- - —` -k Phone No � <br /> f Vehicle License No/State I Truck No <br /> Ackno m Vehicle License No/State <br /> gem -YD <br /> Re aterlals Acknowledgement of Receipt of Materials <br /> $ SN Dole nature LLLLW <br /> � n <br /> OSI 'F� sra n<gate <br /> Rt�i1D I?ARY LANDF ,Y <br /> aW <br /> c Phone No <br /> a Site Name 1 y 5 1116417-4111411114_ <br /> b Physical Address e <br /> d Matting Address <br /> t G 4 5 Ce <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 is true and accur <br /> JbWW 1007/107 <br /> t <br /> Name ofAWhort soACgru s�nrnure PO# 09-31398 <br /> �ShlPpers`s:- <br /> p�ASBE STOS�{eenaratoea-eN <br /> b Shlppers'st Phone No <br /> c Shippers%*Address <br /> d Shlpperst 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, packafF <br /> marked,and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations <br />