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l <br /> Y NON HAZARD`,US SPECIAL WASTE & ,usBESTOS MANIFEST <br /> If waste Is asbestos waste,complete Sections 111,III and 1V r O w O O <br /> If waste is NM asbestos waste,complete only Sections I,II and M ry L � <br /> e Generator Name arm PRODUCTS CQ"Ati y b Generating Location ARCO 8TAT10N #06020 <br /> c Address lace 5077 d Address l�t1711 E. YDal= <br /> BUS'6Ls► PARY., CA 50622-5077 Hu"Er-A, CA <br /> e Phone No (925) 295-6691 VAOL SUPPLE f Phone No WDA <br /> If owner of the generating facility differs from the generator,provide ' <br /> Owner's Name ARCO PRODUCTS CO WARY sty as; 1(e <br /> Q h Owner's Phone No <br /> Y C 4 4S <br /> 0 <br /> 5 329 9 [ aJ 2 Sfl TYPE <br /> I BFI WASTE CODE Containers DM-METAL DRUM , <br /> NON-RUARDOM SOIL BP -BAG TIC DRUM <br /> J Description of Waste k Ou ritity Unds No TYPE BA -6 MIL PLASTIC BAG <br /> 10101 <br /> D o m or WRAP <br /> T -TRUCK <br /> O -OTHER <br /> GENERATOR'S CERTIFICATION I hereby certify that the above named material is hot a hazardous waste as defined by 4o CFR Part 261 or UNITS <br /> arty applroable state law has been properly descntrd, classified and packaged4 and is In proper condition for transportation according to P -POUNDS <br /> applicable regulations,AND,11 the waste is a jreatment poldus of a previously restricted hazardous waste subject to the Land Disposal Y -YARDS <br /> Restrictions,I certify and warrant that the waste has beer treated in pocordanoe 4 the ragwrements of 40 CFR Part 268 and is no longer a M' -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261 '8t. the requeati Of ARCO Palowcm cammy Y3 -CUBIC YARDS <br /> >lFATaIiI DILLi�I{df '3ILtARD F.if)Vr �' c I S ] 5` ,q C7 O -OTHER <br /> Generator Authorized Agent Name Signature Shipment Date <br /> � l� <br /> ' .�` TRANS DATER rterlc4m <br /> T IANSPORTER I TRANSPORTER 11 <br />—a.-Name - ra-4, i/^ (..mow r - - h Name - <br /> b Address �� I Address - <br /> } <br /> c Driver Name/Tid_ rL� �T T - <br /> T j Driver Name/Title <br /> PRi /TYPE y PRItTr/TYPE <br />- d,Phone No - - % -Z e=Truck No � `k-Phoria No- _ — - - - I Truck No <br /> f Vehicle License No./State m Vehicle License No/State - - <br /> Acknowled merit of Receipt of Materials Acknowledgement of•Receipt of Materials <br /> g o a n <br /> Driver S na4ir. — Shi l]aoe Driver SwnagreJ. <br /> Shi Date <br /> a <br /> Sin - YASW RQ%D BAHITARY LMDPUZ, <br /> a. Site Name X925) ��7—OA91 <br /> c Phone No <br /> 40Cj1 H. v�eo �w aoD� N. �scf3 >�� <br /> b Physical Address d Melling Address <br /> v c� 94SSO LaVERNORE,w CA 94550 <br /> e Discrepancy Indicatlon 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 accura <br /> JOa3 1007/107 <br /> fPOO 09-31398 <br /> wine d aW,orfzed Aperp Receipt Dime ` <br /> L <br /> a. Shippers's*Name <br /> b Shlppers's*Phone No <br /> C Shippers%*Address <br /> d ShIPPers's 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 classiried, packag <br /> marked,and la beled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations <br />