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` 3 NON-HAZARD,..,US SPECIAL WASTE & . 5BESTOS MANIFEST <br /> If waste is asbestos waste,complete Sections I,IL III and IV N w'O <br /> If waste Is N.QI asbestos waste,complete only Sections 1,11 and III ■ <br /> 1111i 11;IN I 11 <br /> E mai cnrsilsletes,sli I? i µ . <br /> a. Generator Name b Generating Location <br /> c Address PIM 5077 1711 $, yoglM+E <br /> d Address <br /> 8lJP.l9A PMMe CA 94022-5077 tE.Ch ak <br /> e Phone No (925) 799.8831 PAUL SUPPLE f Phone No N/A <br /> If owner of the generating facility differs from the generator,provide <br /> g Owner's Name ARM P%0r'-'V= COMA" h Owners Phone No SS*--" Ito) <br /> _TJ TYPE <br /> I BFI WASTE CODE <br /> F-4- <br /> M() 5 <br /> O S 3 2 9 9 -O 2 Q S 4 Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM , <br /> J Description of Waste NON-4AZARDOUS SOIL B -BAG <br /> k Quant Units No TYPE BA -6 MIL PLASTIC BAG <br /> or WRAP <br /> Lo <br /> O O ], A = Q 2 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 /> applicable regulations,AND,if the waste is a treatment residue of s prsviousty 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 266 and is no longer a M' -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261 at the.regtseSt of ARM Y9 -CUBIC YARDS <br /> r i ! { O -OTHER <br /> Generator Authorized Agent Name Signature Shipment Date <br /> 01 -001%,1101. TRANSPORTER _�`re�torfi ple�te �r ire p11 te'l <br /> TRANSP77h <br /> 8 I TRANSPORTER II <br /> a Name ;'1 r}1'� ,�- Name "As- - - <br /> b Address ^ <C: [ < ~� tr�F le ►a 1 Address <br /> � 6-- Cr* <br /> - c Driver Name/1-itle j Driver Name/Title <br /> ,y PRIh1T/rYPE PRINTfrYPE <br /> d _Phone No - t_ -e Truck filo = 'j 7 -k Phone No - _ W- y �I -Truck No <br /> f Vehicle License No/State L 14-1m Vehicle License No/State <br /> Acknowledgement of Receipt of Materials Acknowledgement of Receipt of Materials <br /> n <br /> FT <br /> nriuer <br /> Date Driver n8dlra Shl Data <br /> A*,Site Name "" PASO ROSD 2"=` I. IIZ^Fc Phone No 9 3 '"4¢g1 <br /> 1001 li, VA>ifG4 >lWRD ' <br /> b Physical Address d Mailing Address �� �� VA'$C�O �!D r <br /> Z"WINMR• Ch 9+550 - ____■ <br /> LT91101110R8o Ch 94SSO <br /> a Discrepancy Indication Space <br /> I hereby certify that the above named material has been accepted and to the best of my knowiedge the foregoing is true and accurate <br /> JOB# 2DC7/147 <br /> f Llwine aAuciwr�ae,rpeiit Rpr iota 09-32396 <br /> a. Shippers's"Name b Shippers's"Phone No <br /> c Shippers's"Address <br /> d $hipperst 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, pecks <br /> marked,and labeled/placarded,and are in all respects in proper condition for transport according to applicable International and national governmental regulations <br />