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NON-HAZARG._.US SPECIAL WASTE & L_SBESTOS MANIFEST <br /> i <br /> If waste is asbestos waste,complete Sections I,IL ID and IV N O. C�A A <br /> If waste Is NM asbestos waste,complete only Sections I,It and III 57 L L <br /> x <br /> 21 <br /> r <br /> a Generator Name ANIM gW:*VB £CNPA" b Generating Location ii-AN2 STA'3 M #06020 <br /> c Address POR 5077 d Address <br /> WAM PARA, CA 90622-5077 <br /> e Phone No (925) 291-8691 PAUL SUPPLE f Phone No <br /> If owner of the generating facility differs from the generator,provide , <br /> g Owner's Name At= PRDI'4XTS COWART h Owner's Phone No Sasae an I(e? <br /> 1 BFI WASTE CODE C A 4 O 5 0-15 1 1-2 f 9 <br /> TYPE <br /> O ? 0 5 Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> `�S SOIL B -BAG <br /> j Description of Waste k Ouant unds No TYPE BA -6 MIL PLASTIC BAG <br /> or WRAP <br /> 0 Q O Y O 1 T -TRUCK <br /> • O -OTHER <br /> GENERATI}R'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 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 26B and is no longer a M' -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Pan 261 at thereq � tD r laA Y3 -CUBIC YARDS <br /> i '4 4 O -OTHER <br /> IItIMIM R' EIfff nor-TARD Ef aRiMe <br /> - Generator Authorized Agent Name Signature r�`-^ t Shipment Date <br /> tSeC d° �ANSP�RTECI (}ewer plata rF'°rt`�`er' $�rr�'ll �' <br /> TRANSPORTER I TRANSPORTER II - <br /> DILLAM TRUMING� 11;C. <br /> —a-Name -- - - — — - - - h Name - <br /> b Address PW $79 i Address <br /> STAMe CA 94514 <br /> - a Driver Namell'ltie = — - el —ZDrhrer Name/Title - <br /> (925) 684-685Q PR""'T E PFUNrmPE <br /> d -Phone No - - - - -- -- a Truck No - - -k-Phone No - - - — I Truck No <br /> IF Vehicle License NoJState ` e" �~ 7. �f m Vehicle License No/State <br /> Ackrto emdnt of Recelpt of Matenals Acknowledgement of Receipt of Matenals <br /> Driver ShWwdrd Data Driver skinal Shle=Date <br /> a. Site Name WX - VAGOO R= SMITART LAI& c Phone No 1925) 447-0491 <br /> b Physical Address 4001 M• VIII Rib U-M Ko VAS00 ROAD <br /> � d Mailing Address <br /> LIVER111111=# CA 94550 LXVEPJK=t 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 accxirate <br /> JOSIF 1007/107 <br /> f P00 09-31398 <br /> Nano d A l twrizad AveraSipnahus Receipt Data <br /> a w1am-M a <br /> z <br /> a. Shipperw Name b Shippers's"Phone No <br /> c Shippeirsi 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 classified, packs <br /> marked,and labeled/placarded,and are in all respects In proper condition for transport according to applicable international and national governmental regulations <br />