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r <br /> r NON•HAZARL.._.�,US SPECIAL WASTE & SBESTOS MANIFEST <br /> If waste is asbestos waste,complete Sections I,II,III and IV— <br /> If If waste is N_QI asbestos waste,complete only Sections t,iI and III <br /> _..�. l �� fE # R <br /> * a+ �.. ,t� t- <br /> o<Nt1 et .5eollOrk � ' l� a «° <br /> FGene,at,riName aRW 11�R $ CONPARY b Generating Location ARCO '.S'1'A't'IM #06020 <br /> c Address PCO 5077 <br /> d Address 1 71 2 E. YOSEMITE <br /> 1 $MIA PAi, P CA 9Ob22-5077 ".AAi` MA, CA <br /> e Phone No (925) 29r="`$89I PAWL SUPPLE <br /> f Phone No N/A <br /> owner of the generating facility differs from the generator,provide <br /> Owner's Name '» PRODUC" COWAW h Owner's Phone No 84M* as 1(e) <br /> BFI WASTE CODE C A O S 0 '3" 1 2 � 0 2 0 5 <br /> F] TYPE <br /> Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> Description of Waste til7Qfr1 AZAVI]WS SOIL B BAG <br /> k Quanti Unas No TYPE BA -6 MIL PLASTIC BAG <br /> 07�1 ( I T -TRUCK <br /> WRAP <br /> O -OTHER <br /> or 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 taw, has been properly described classified and packaged and is in proper condition for transportation according to p -POUNDS <br /> applicable regulations,AND,if the waste Is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Y -YARDS <br /> Restrictions,I certify and warrant that the waste has been treated in accordance with the requirements of 40 CFR Part 268 and is no longer a - <br /> hazardous waste as defined by 40 CFR Part 261 <br /> at, M' CUBIC METERS <br /> �� of P ! Y3 -CUBIC YARDS <br /> P1lC�lj p ,RG OILLTitD ti'31W i}"F t O -OTHER <br /> Generator Authorized Agent Name Signature Shipment Date <br /> E � kk - �TRA�SP ,ATER Generatorcompletaaa4�Tra�irrortpi v ° P z <br /> TRANSPORTER I l <br /> h Name TRANSPOR7�R II <br /> b Address ( r I ' (~ pr E I Address <br /> c Driver Name/Title # I Driver Name/Title <br /> PR)WfTYPE <br /> Phone No �� ( e Truck No �F k Phone No I Truck No PRINTrrYPE <br /> Vehicle License No/State 3 c� -, m Vehicle License No/State <br /> Acknowledgement of Receipt of Matenals Acknowledgement of Receipt of Materials <br /> �- _ n <br /> s" t rate t�tvor s nanrre LIT <br /> s� Date <br /> Site Name Jun — v>st'o S11�i1�'71ldtY ra►eto s,L (925) 4;7-<,49 <br /> - 4001 �• ��� � c Phone No _ <br /> b Physical Address d Mailing Address 4001 9• VAS40 RMO <br /> LIY1�60REv G 94550 <br /> V=WQR8• CA 94550 <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 /> JCB# 1007/107 <br /> r <br /> Narne of FaOWdzsd Aaarn09—31390 <br /> , Reodpt Date POS <br /> ippers's*Name <br /> b Shippers's*Phone No <br /> lshippers%*Address <br /> J Shippers's Special Handling Instructions and additional information <br />�'FATIONI hereby declare that the contents of this consignmentnd labeledlplacarded,and are in all respects in proper condition for transport according to applicable International and national governmental regulations <br />