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uYNON-HAZARD...P(US SPECIAL WASTE &�.ZBESTOS MANIFEST <br /> If waste is asbestos waste,complete Sections 1,11,III and IV C <br /> If waste is hM asbestos waste,complete only Sections L II and N0.512257`.'NO f t'�a Generator Name ARCO �8 COMWAN'r b Generating Location nM <br /> P:i`ATION oft03Q <br /> c Address POB 55077 d Address 1721 E. YWEmITE <br /> BUEM Pte, CA 90572-5077 M3 %V=. Ca <br /> e Phone No (925) 29`i-8891 PAUL SUppLE f Phone No 1111A <br /> If owner of the generating facility differs from the generator,provide <br /> g Owner's Name AS= F> M COMAl1sY h Owner's Phone No Barts*_AB 11*111Z <br /> I BFI WASTE CODE C A 4 Q 5 1015 11LZ 9 0 2 0 5 0 Containers DM-METAL DRUM <br /> DI' -PLASTIC DRUM <br /> I Description of Waste 0DR-•FI EARDOW SnTL B -BAG <br /> k ;1HD <br /> Units No TYPE BA -6 MIL PLASTIC BAG <br /> or <br /> 0 1 T -TRUCK <br /> O -OTHER WRAP <br /> GENERATOR'S CERTIFICATION t hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Part 261 or « rrs <br /> any applicable state law, has been properly described, classified and packa4ed and is in proper condition for transportation according to P -POUNDS <br /> applicable regulations,AND,If the waste Is a treatmen residue'of a prevlo sly restricted hazardous waste subject to the land Disposal Y -YARDS <br /> Restrictions,I certdy and warrant that the waste has beqrn treated Irl acro anre with the requirements of 40 CFR Part 268 and is no longer a M' -CUBIC METERS <br /> hazardous waste as defined by ao CFR Part 261 a i~ tl�e r ?St of 'ARMY' <br /> -CUBIC YARDS <br /> •-' „- l f / O -OTHER <br /> Generator Authorized Agent Name Signature Shipment Date <br /> ��+� TRANSPQRER or,er oE �ia�a;Tnporcerr�m�let+� e -z _ 7 <br /> Trans r li co late A a �,�'4��1 _ <br /> _ TRANSPORTERI _ TRANSPORTERII -� <br />—a-Name r-,---- - --- — - - -- - - - - h Name <br /> , <br /> b Address c % r s y I Address <br /> C, <br /> :A � <br /> c Driver Name/Title `�. ..�- = E ; 1 L -i ,_ - _ - I =Driver Name/Title <br /> PRINTINPE _ PRINT/TYPE <br /> d Phone No s !- - f t 2-- --e Truck No= iA-' - 4 J -k-Ph- <br /> one No- —-- -- - I Truck No- - - <br /> f Vehicle License No/State ' t r i <br /> - -m Vehicle License No/State <br /> Acknowledgement of Receipt of Materials Acknowledgement of Receipt of Matenals <br /> Drhi.r T n I TTA <br /> SNpmerd Date Driver nanrre Silipment Data <br /> PE !1111 <br /> a. Site r an — VA.4000 RMD Surra: L L 92s f Z—oa9 _ <br /> r c Phone No <br /> b Physical Address 4&A We VASC30 � <br /> _ d Mailing Address 4001B+ V1�9CO ROAD <br /> LIY�t1i10=6 CA 9455Q LIVERNIMAil CR 945:x() <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 /> -- JM# 1037/107 <br /> f <br /> Narm of Aulriortaed a Raoeia oaea PO$ 09-31398 <br /> a. Shippers%•Name b Shippers's•Phone No <br /> c Shipper %-Address <br /> d Shippers's Special Handling Instructions and additional irdorrnation <br /> CERTIFICATION +•f hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packag <br /> marked,and labeled/placarded,and are in all respects in proper condition for transport according to applicable International and national governmental regulations <br />