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ti3 \ , <br /> NON•HAZAR�...��S SPECIAL WASTE & �.ABESTOS MANIFEST <br /> If waste Is asbestos waste,complete Sections 1,H,III and IV <br /> If waste Is NQI asbestos waste,complete only Sections I,R and III No-512260 <br /> Generator Name Xl ORCRUC" C"WA" b Generating Location NN22 MMTU*t fo(yO;K! <br /> c Address PCs 5077 d Address 1711 E. YOMITC <br /> SUM PAW& CM 90622-x5077 XNWfECX1CA <br /> e Phone No (925) 299-"41 pAUL SuppLE f Phone No N/A <br /> owner of the generating facility differs from the generator,provide <br /> Owners Name ARM PRODUCTS COOHPAWY h Owner's Phone No Slttae as If to) _ <br /> BFI WASTE CODE C A 4 5 [013 12 19TYPE9g p <br /> Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> Description of Waste Ia14M--»kRpW$ &D1Z B -BAG <br /> k Ouanti Units No TYPE BA -6 MIL PLASTIC BAG <br /> or <br /> d 0 0 RL' a d 1 T -OTHER WRAP <br /> GENERATOR'S CERTIFICATION I hereby certify that the above named material is not a hazardous waste as defined by 40 CFA Part 261 orN T <br /> any applicable state law, has been properly described, classified and packaged, and is in proper condition for transportation according to P -POUNDS <br /> S <br /> 1 applicable regulations,AND,if the waste le a treatment riesldue of a previously restricted hazardous waste subject to the Land Disposal Y -YARDS <br /> RastdctiOns,I cerUly and warrant that the waste has been treated in accordance with the requir9ments of 40 CFR Part 268 and is no longer a M' -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261 a X".:.t t +f ARCO up=ICTS ccal ACM Y' -CUBIC YARDS <br /> O -OTHER <br /> Generator Authorized Agent Name Signature Shipment Date <br /> " <br /> tRANSRTER* , <br /> � t zPO �° Generatorc6mple� �u a e*e , ` <br /> TRANSPORTERI <br /> 11 TRANSPORTER H <br /> Dame 02,f PJ r f r It k. <br /> h Name <br /> b Address {� �� �1 ._ r ,r } <br /> I Address <br /> c Driver Name/Title 4- `� .-c.. !! ;t ' c K <br /> j Driver Name/Title <br /> PRINT/TYPE <br /> Phone No a Truck No [/ k Phone No PR NTfrYPE <br /> I Truck No <br /> Vehicle Llcense NodState 11 � ` '✓{r ^" _ m Vehicle License No./State <br /> Acknowledgement of Receipt of Materials Acknowledgement of Receipt of Materials <br /> 1 4 _ <br /> t7rn.r nawa. n <br /> vT <br /> weI Drt w s I <br /> ire sn1 _Data <br /> Site Name BYI " VA`=0 ROAD SANITARY LA41lWU.L tI92 5) 447--0491 <br /> c Phone No <br /> b Physical Address 4001 R• VASC0 ROAD 4001 H. Vkssm RQIAD <br /> d Mating Address <br /> LIVMU4 REI Ch 945s0 LI@MMDM, G 94`i5ti <br /> e Discrepancy indication Space <br />'I hely certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> JOB! 1007/107 <br /> f <br /> of Authortred spentStrom- Reoasa ome POO 09-31399 <br /> fhipfppers"s•Name b Shippers's*Phone No <br /> pers's*Address <br /> I SNP"Special Handling Instructions and additional Information <br /> TlF1CATION• l hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are ctassified, packaged <br /> ed,and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations <br />