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{ <br /> NON-HAZARDOUS SPECIAL WASTE & ._IBESTOS MANIFEST <br /> If waste is asbestos waste,complete Sections I,II,III and IV } <br /> If waste is NQI asbestos waste,complete only Sections 1,II and III No- 512275 <br /> a Generator Name ARCD PRODUCTS COWARY b Generating Location ARCO 8' TXON #06020 <br /> c Address PM 5079 d Address 1731 E. YOS1041TE <br /> BUMS P9RRX& Q 90622-5077 M_'.fQTlO[:A, CP. <br /> e Phone No (925) 299-M2 PALM. SUPPLE f Phone No "A <br /> If owner of the generating facility differs from the generator,provide <br /> g Owner's Name ARM PRIODOM COMPANY h Owner's Phone No Same a8 2(a) <br /> S <br /> i BFI WASTE CODE 2Q 2 050 RE <br /> Containers DM-METAL DRUM , <br /> DP -PLASTIC DRUM <br /> NON-DRi= Sp=y B -BAG <br /> Description of Waste k QuantM, Unds No TYPE BA -6 MIL PLASTIC BAG <br /> or NO <br /> d <br /> 0 1 T -TRUCK <br /> 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 properly described, crajssified and packaged, and is in proper condition for transportation according to P -POUNDS <br /> applicable regulations AND,If the waste is a treatment r8sldue 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 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 wt the xt-4�z t of ARCO FRODU , _ p Y Y' -CUBIC YARDS <br /> PATRIMA PILLARIOZ DILLARD SIMV =� O -OTHER <br /> f t 4 r <br /> Generator Authonzed Agent Name Signature Shipment Date <br /> - <br /> � a '> � RANSP�OR El3� <br /> 'comp <br /> hwlh <br /> We <br /> TRANSPORTER I TRANSPORTER U <br /> 1 <br />—a—Name . , - h Name - <br /> b Addressf1 i Address <br /> r <br /> c Drlver NanteMUe = Driver Name/Trtte -_ _ — - _ <br /> PRaYT E PRINTRYPE <br /> d Phone No Z ' - - _L -- a—Tick Na k Phone No T T LL t Truck No <br /> f Vehicle License No/State' - m Vehicle License No/State <br /> Acknowledgement of Receipt of Materials Acknowledgement of Receipt of Materials <br /> 9n+� ITTETI <br /> privar naturo H +std to' Drivers riehrre <br /> F"Prnont Date <br /> a <br /> Site Name ASI ROMs SAXITARY LANDFILL. �# (925) "7-0491c Phone No <br /> b Physical Address 4003L d{ Vr�i9l�D ROAD 4001 too vASpO Rt�,D <br /> d Malling Address <br /> Lz�, X1550 LIQ, CA lllii <br /> e Discrepancy Irldicatrlon Space <br /> I hereby certify#mi the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> JCis# 10(37/107 <br /> f TT >� 09-3139$ <br /> Noma ar Authafmad ApartSO-two <br /> Receipt Data <br /> a. Shippers's*Name b Shippers's*Phone No <br /> c Shippers%*Address <br /> d Shippers%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, packag <br /> Am <br /> marked,and labetedlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations <br />