Laserfiche WebLink
NON-HAZAREI.dUS SPECIAL WASTE & . Z13ESTOS MANIFEST <br /> If waste is asbestos waste,complete Sections I A In and IV No- 512261 <br /> ,O i <br /> If waste is hM asbestos waste,complete only Sections I,II and III, 1 r 1 1 <br /> '�- ..5 et]e ..wrr rgr�e�all� aJt"���gx'���`Y �� r`�9 ��yt kfr�r Y}✓e £z v <br /> AV= P"Ilum COMPRIJY ARM sTA';'Int�1 #%- 020w <br /> a Generator Name b Generating Location <br /> c Address POB 5077 d Address 1711 S' YOSM',ITE <br /> �1 <br /> m QARX, CA gov C-50 T7 <br /> (925) 2SMJ-8691 PA[I. SUPPLE <br /> e Phone No f Phone No <br /> If owner of the generating facility differs from the generator,provide <br /> AI�I00 PRODUCTS Co"ANX Same as x(e) <br /> g Owner's Name h Owner's Phone No <br /> C A 4 OS05 112 9 02 050 3� <br /> i BFI WASTE CODE Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> E�ZARrMB SOIL B -BAG <br /> l Description of Waste _ k Quantr Units No TYPE BA -6 MIL PLASTIC BAG <br /> or WRAP <br /> 0 0 D Q x 0 -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, d�ssified and packaged, and is in proper condition for transportation according to P -POUNDS <br /> applicable regulations,AND,It the waste is a trsatmentraesidue of a previously rgstrleted hazardous waste subject to the Land Disposal Y -YARDS <br /> Restrictions,I certify and warrant that the waste has been eat in ordance yy��ii��h th reX�r�eny� f 4 F rtn�� no longer a M3 -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261 .Qt,1eQtSt �I httC.L7 P� �r Y3 .CUBIC YARDS <br /> PATRIC7A DUJ-MM/ DUJAARM RNV. - � ! O -OTHER <br /> Generator Authorized Agent NameSignature Shipment Date <br /> SOvkIT ne"rato i $- iter> �t.0 t � ,:' `�M `_. y <br /> TRANSPORTERI - TRANSPORTERII <br />—a-Name ` '.t_- ---- - - i/_ - - - h-Name - - <br /> As <br /> b Address 1 •1 sr �, <br /> ,� <br /> •, .._. i Address <br /> =K <br /> c Driver Narrie/Title T . ' j =Driver Nae/Tftle=_ -__ - -- _ - - - - <br /> _ PRINT � —r L �� mPriINT/rYPE _ <br />- d Phone No -- - ,= y '— a-Truck No -- - -k Phone No - ____ - -- - - - -- I Truck No <br /> f Vehicle License No/State ., -;;� iJ t.; "�' ��y m Vehicle License No./State <br /> Acknowledgement of Recqtpt of Materials Acknowledgement of Receipt of Matenals <br /> 9 : 1 k I'd` <br /> f <br /> n <br /> °" s sni Mato <br /> Dr*w Sionaftme stpl Dat. <br /> MOW <br /> a Site Name 4QLW Cc 4- VASCO TV 91111 c Phone No ■ _ - <br /> b Physical Address d Mailing Address <br /> s v <br /> a C%__W550 -A <br /> e Discrepancy Indication Space <br /> 1 hereby certify that the above named material has been accepted and to the bent of my knowledge the foregoing is true and andir I007/107 <br /> f A <br /> Au � 09-31390 , <br /> rJasrria of lnortzed yerq sionaa,r. necelpt Date <br /> a Shippers*Name b Shippers`s*Phone No <br /> c Shippers's*Address <br /> d, Shippers%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 stripping 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 />