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NON- ARI -SUS SPECIAL-WAST -&� SBESTOS MANIFEST , <br /> � HAZ E <br /> If waste Is asbestos waste,complete Sections 1,11,III and IV .�j ��I <br /> If waste is NQI asbestos waste,complete only Sections I H and IINO. S1 <br /> I N <br /> H RT <br /> Generator Name AFICI0 P1m0UCfS 00lfPMY b Generating Location ARW MT1010 #06020 , <br /> Address XW 5077 d Address 1711 a• Tomlim <br /> >SUMM PARS# CA 90622-5077 Kwnwke CA S <br /> Phone No (925) 299-43591 PAUL SUPM& f Phone No N/A <br /> owner of the generating facility drffers from the generator,provide <br /> Owner's Name ARCO PROS (SA" h Owner's Phone No $lar& an Z(0) <br /> C A 4 05 05 1Z r 111 02 1 350 � <br /> BFI WASTE CODE - 1Ll Containers DM-METAL DRUM , <br /> DP -PLASTIC DRUM <br /> 110ff-hAZARD= SOIL B -BAG <br /> Description of Waste k Ou ntity Units No TYPE BA -6 MIL.PLASTIC BAG <br /> Nor dOVE N <br /> m KWRAP <br /> 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 UN <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 Pan 261 at t),* requw1 of APCO �'ts .?l�C.'M WIPANY Y3 -CUBIC YARDS <br /> f, O -OTHER <br /> NBLISSA KIRM/ DrLLI W VNIVIRM. d <br /> Generator Authorized Agent Name Signature Shipment Date <br /> o Ta, Tra1f <br /> RANSPORTER erleratof ompi a d, Transn tort'tete h n J vl <br /> TRANSPORTER I TRANSPORTER II <br /> DILLaARD TRUCKING, 14C, <br />—Name- ------ - - - h Name <br /> 1100 579 <br /> Address i Address <br /> BYRMO CA 94514 <br /> Driver Name/Title �.+rJ _ �' I Driver Name/Title <br /> PR <br /> INTrrYPE PRINTIrYPE <br /> -Phone No -- - - - - --e-Truck No - -- - -k-Phone No - - -- —1-Truck No - -- <br /> Vehicle License No/State 1 / r` K - - _ m Vehicle License No/State <br /> Acknowledgement of Receipt of Materials Acknowledgement of Receipt of Materials <br /> Driver ftneture SNWWK awe Ddvw Signature shi Date <br /> W I -- VAWO RCL D SAnITA]RY LANDFIL f925) 447-0491 <br /> Site Name c Phone No <br /> 4_101 N, VASCO I' ZD 40i:1 N. VA= ROAD <br /> Physical Address r d Mailing Address ' <br /> i. '!�*�:QI:r`, ' <br /> 12A ��5G Y..IVER►301r2fs, CA 94550 <br /> 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 a��e 1007/107 <br /> PO4 01-313:=5 <br /> Name of Autivraed Agent Signature Receipt Date <br /> ki <br /> *P01i IV � � '� �r r ASBESTOS ftl�rleratarcorn itete a f,a,sh,pper oompleies e <br /> Shtppers's"Name b Shlppers's"Phone No <br /> Shtppers's•Address <br /> Shippers's Special Handling Instructions and additional information <br /> ERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packaged,l <br /> arked,and labeled/placarded,and are In all respects in proper condition for transport according to applicable International and national governmental regulations <br />