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® ] 1 <br /> j NON-HAZARVP,,wUS-SPECIAL WASTE & --lix"BESTOS MANIFEST <br /> If waste is asbestos waste,complete Sections I n,ID and IV No- 512277 r- <br /> If waste is�asbestos waste,complete only Sections I,11 and • a <br /> NF1 <br /> a Generator Name b Generating Location MM MTION3 #OW20 <br /> c Address ]E`er 5077 d Address 1711 B. YdMrM <br /> DUMP! PARS, CA 90622-5077 MAWR>ElAa CA <br /> e Phone No {525) 299-8891 PAOL f Wxx f Phone No R/A <br /> If owner of the generating facility differs from the generator,provide <br /> g Owners Name ARM P*00(=8 SAM h Owner's Phone No I EB S <br /> Qs � � s FolJ osv i BF]WASTE CODEContainers DM-METAL DRUM <br /> �ixi'lln � DP -PLASTIC DRUM <br /> as <br /> Description � <br /> ption of Waste k Quantity units NoB -BAG <br /> TYPE BA -6 I PLASTIC BAG <br /> or I0 0 O j 0 1 m T TRUCK 1 .OTHER WRAP <br /> GENERATOR'S CERTIFICATION I hereby certity 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 268 and is no longer a M' -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261 at, the ,r ft.Ame>t: of ARCO PROLly'-T,; Y' -CUBIC YARDS <br /> PATRICIA DILLARD/ DILLARD MV. ---� I , I J 4 'e 11 O -OTHER <br /> Generator Authorized Agent Name Signature y M h Shipment tate � <br /> it F-u.'K.s,y-k-awav x 'R L'F SY`vXR��" ti 'E &_ <br /> TRANSPORTER generatorcormpletea=, TrensVrttel ror 'betah ��� � <br /> TP%ANSPORTER I TRANSPORTER II <br /> a Name , <br /> - h Name - - - - <br /> b Address c��f%r i 1 LL f i Address <br /> 7 _ <br /> c Driver Name/i`dle = ' _ ;� c.�; —�, ��~_ -�r~= = 1 Driver Name/Title <br /> RiNT/TYPE PRINTRYPE <br /> d-Phone No r- , , 1, `' _ _e-Truck No -- -k Phone No ---- ---- -- - -- I Truck No - - <br /> ;Ve J.pense No./ to --{ a m Vehicle License No/State <br /> ment of eceipt ofrMaa mals Acknowledgement of Receipt of Matenals <br /> f / <br /> n <br /> Date I t&.w nwwre Shi Date <br /> -, <br /> a. Site Name ` _ IT ? c Phone No (925) 447-0491 <br /> __ - <br /> b Physical Address 4001 . VASM RCLW <br /> d Mailing Address <br /> LIVZRM E. CA 94550 LIY , 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 /> _ J� 1t� <br /> $ 07/107 <br /> f P46 t79-31�9J1 <br /> Hems d AtBhprtYed Agent Sipnsowa Receipt Data <br /> mum <br /> a Shippers%*Name b Shippers%*Phone No <br /> C Shippers's*Address <br /> d SNPIP O Special-Handling Instructions and additional Information <br /> CERTIFICATION f hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packag <br /> marked,and labeledlplacarded,and are in all respects In proper condition for transport according to applicable international and national governmental regulations <br />