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m <br /> NON-HAZARD,.,0$ SPECIAL WASTE & ,-,sBESTOS MANIFEST <br /> If ff ate Is asbestos waste,complete Sections I H,III and IV No-512256 <br /> I III <br /> asbestos waste,complete only Sections I,H and <br /> h <br /> Generator Name AJ= PRODLXVS (70MAM b Generating Location ARCA STATIM 1006020 <br /> c Address PW 5077 d Address 1711 E. YOSMITE <br /> 1 SUM PXW, CA 90622-5077 10x".Dm, ca <br /> e Phone No (925) 299-8891 PAM SUP:yLE f Phone No R/A <br /> owner of the generating facility drffers from the generator,provide <br /> Owner's Name ARM MOM= (X*WA%W h Owner's Phone No Sri BA <br /> BFI WASTE CODE C A 4 0 5 0 5 1 2 9 O 0 5 0 TYPE <br /> Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> Description of Waste "MZARDWS SAIL B -BAG <br /> k Quant Units No TYPE BA -6 MIL PLASTIC BAG <br /> 0or WRAP <br /> d 0 Y 0 1 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 packagled, and is in proper condition for transportation according to P -POUNDS <br /> applicable regulations AND,If the waste la a treatmens-residue of a previously restricted hazardous waste subject to the Land Disposal Y -YARDS <br /> Restrictions,I certify and warrant that the waste has bean treated in aocordanoelwdh 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 � kho <br /> rteglaeSt of ARCOp �t Y3 -CUBIC YARDS <br /> ,�- O -OTHER <br /> Generator Authorized Agent Name Signature k �" LLL I <br /> Shipment Date <br /> TRZ SP�RTER Generator complete j�d, Trreansj�orter Mm�plate e-g <br /> it cc ete. <br /> TRANSPORTER <br /> TRANSPORTER II <br /> ame h Name <br /> b Address <br /> I Address <br /> r f i r 'I G <br /> c Driver NamefMa ' j Driver Name/Title <br /> PFuNTr YPE <br /> Phone No c - rFrYPE <br /> �' e Truck Nok Phone Nolri Truck No <br /> Vehicle License No/State t m Vehicle a License No/State <br /> Acknowledgement of Placer #of Materials Acknowledgement of Receipt of Materials <br /> d � <br /> t�rwer naew n <br /> &OR=oat, Driver ftnalxire Dwa <br /> A <br /> rsfteName 9X — VAS00 Rc" SMX'AR7 LA,HprI IL c Phone No (9") 447-0491 <br /> b Physical Address 4001 N• YAC 0 RUAU 4001. N. VASM ROAD <br /> d Mailing Address <br /> i.IVERba e CA 9550 Livnil gme CA 9455%) <br /> e Discrepancy Indication Space <br />'I hereby certify that the above named material has been aocepted and to the best of my knowledge the foregoing is true and accurate <br /> JCS# 1007/107 <br /> dAutigrizsdA +re Li PI)f 09-31398 <br /> R*004*Date <br /> Ippers%*Name b Shippers's*Phone No <br /> hippers%*Address <br /> J Shippers%Special Handling Instructions and additional information <br /> TIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packagec <br /> ed,and tabeledlplacarded,and are In all respects in proper condition for transport according to applicable international and national governmental regulations <br />