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f NON-HAZARL_..�US SPECIAL WASTE & SBESTOS MANIFEST <br /> 1 <br /> If waste is asbestos waste,complete Sections 1 If,11I and IV O. w <br /> If waste is NOT asbestos waste,complete only Sections 1,II and III 1 <br /> Ay��'%�`° 3t�,'�,:x^�3a_} S H^� � ty e'S� i'�i �ENE�ly�� //�]��J�r�..�^_s. fM 9 �n(f �S <br /> �,n ;„ Y P li f r �c F -'- RATOR fG""ator 9 mpletes all OrE�Ion W '_t <br /> a Generator Name ARMs PRODU TE CaIPANY ARCX! S:'A�x'ION 0 '60:0 <br /> Poen !)u77b Generating Location <br /> c Address 1711 t:. Yr',5F 0,1 E; <br /> d Address <br /> ..LfTXV' PAPUK, CA j00622--507'r Tlh:T4`F�C�' , CA <br /> (925) 2 991—U-91 3jo bUYPt.,F N/Ae Phone No f Phone No <br /> owner of the generating facility differs from the generator,provide <br /> AMPR(X[)C4 S C�PAt,NY cjamc e T(e) <br /> Owner's Name h Owners Phone No <br /> D5 112 9 02 4S '' TYPE <br /> BFI WASTE CODE Containers DM-METAL DRUM <br /> NLV—HAZARD'_JS SOIL B -BAG <br /> AAG DRUM <br /> Description of Waste k Ouanti units No TYPE BA -6 MIL PLASTIC BAG <br /> 4 (� d 4 1 m or WRAP <br /> T TRUCK <br /> O -OTHER <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 /> 1 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,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 <br /> hazardous waste as defined by 40 CFR Part 261 a t the reque rt Of ARCIfa P , Y' -CUBIC YARDS <br /> AO -OTHER <br /> Generator Authored Agent Name Signature Shipment Date <br /> C <br /> C)1011 ' '``� �� 'f L TRANSPORTER Generatorcomplete a-d, Tmnapa r II epi a hgii <br /> t <br /> TRANSPORTER] TRANSPORTER If <br /> ON ame � f fir' �! G' h Name <br /> } <br /> b Addressril- i Address b <br /> c Driver Name/I"ttie !- )-I I Driver Name�tle <br /> �PHINT"E / PRIWIWE <br /> Phone No . e Truck No / k Phone No I Truck No <br /> Vehicle License No/State <� r <br /> _71:7 m Vehicle License No/State <br /> Ackno Igerriet o Rene t of atenals Acknowledgement of Receipt of Materials <br /> gjfj I I q Iq <br /> rieturo n <br /> Driver S _'tura <br /> S O vfi ryr bx - Stu Date <br /> Site Name BFI VA;3CQ ROAD RANI i ARY I.ANDFII.L <br /> t925�) 447S;*� <br /> c Phone No <br /> b Physical Address 4!*1 N' V&SCo RSD 40C1 N. Vim} ROAD <br /> LIV <br />' d Mailing Address <br /> BJillOIE, CA 94550 LIVMMORA, CA 94- <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 accurate <br /> JOS# 1007/101 <br /> fLi <br /> Named Airotart:ed Aperta PC# 09-31398 <br /> S�r Receipt gate <br /> BEw _ Y i �, a <br /> hipper'''*Name � a � �� ���.'� <br /> b Shippers%*Phone No <br /> 5hippers's*Address <br /> d Shippers5 Special Handling Instructions and additional Information <br /> RTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified packagr <br /> rked,and labeled/placarded and are In all respects in proper condition for transport according to applicable international and national governmental regulations <br />