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NON-HAZARCLJJS SPECIAL WASTE & 1 iBESTOS MANIFEST <br /> if waste is asbestos waste,complete Sections I,II III and IV No. 512214 <br /> If waste Is NQTT asbestos waste,complete only Sections I,H and M <br /> �E <br /> N EAATQ <br /> 'GER�(( r t Ant flCfS �f � a2 3 "ate" " <br /> Generator Name AR )l Pflt0_-4 T8 COKPAt Y b Generating Location X= ST?ITI0" #06020 <br /> c Address POD 50}7�7��r �yf cn w� d Address 1711 B• YOSEWTE <br /> I <br /> L' ,RK, CA 90622-5077 Nh"TTM• CA <br /> e Phone No (925) 29'-8$91 PAUL SUPPLI f Phone No <br /> wrier of the generating facility differs from the generator,provide <br /> Owner's Name ARM PRC}CC=S O MPA"y h Owner's Phone No S" 'aS I(49) <br /> f� A 4 05 129 9 ox o5a TYPE <br /> BFI WASTE CODE Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> NOR—RAZARLOUS SOIL B -BAG <br /> I Description of Waste k Quant units No TYPE BA -6 MIL PLASTIC BAG <br /> or <br /> E Q 3 T -TRUCK <br /> O -OTHER WRAP <br /> GENERATORS 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 GFR Part 268 and is no longer a M' -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261t Y3 CUBIC YARDS <br /> afw the >~aagt�st �{� A;�C'n P <br /> O OTHER <br /> >"4Pj.TSS� K3Etyf nn.T.agp ft4it/I32f]ti_ ! r f <br /> Generator Authorized Agent Name Signature Shipment Date <br /> �'' x TransporterTcoe-g _ <br /> 2CiLiD - TRANSPORTER {Generetorcoroetee-d, trans eritre teAtrteehn <br /> TRANSPORTER I TRANSPORTER H <br /> skme DILLARZ 7RUCK104G, It3.`, h Name <br /> b Address POS .;79 t Address <br /> BYRON, CA 94514 <br /> c Driver Name/Titte t Driver Namefritle <br /> {92`? 63,1—G850 PRINT/TYPE PRINr/rYPE <br /> Phone No _ e Truck No ` k Phone No I Truck No <br /> It Vehicle License No/State rr _ _ m Vehicle License No/State <br /> Acknowledgement of Receipt of Materials Acknowledgement of Receipt of Materials <br /> - ` - I n - <br /> Drrdw Sionawre Shipment Date I Dnver Sm3nature Sru ment Ciate <br /> DESTINATION o �- d nator s41,�omp�tes ef yod � R <br /> Site Name F I VASCO ROAD SAUITAPY LhUDF114, c Phone No <br /> Physical Address 4<QI N. VxXCO kGAr d Mailing Address 4003 ti, tr; �'O r;OAD <br /> ILI V R*iOWt , r'A -o45 : L 14.`A AO-i.1 CA Ls A 5 5 , <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 I r .1'30,7/I07 <br /> 0= i-C4 15^ 3- 3r�t' <br /> FN or Auth aed Agent Signature Receipt Date <br /> wIii - ASBESTOS JGenerator complete aA,f,g,shipper*completes e) <br /> pers's"Name b Shippers's'Phone No <br /> pers's'Address <br />�Shippers's Special Handling Instructions and additional information <br /> kRTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified packaged <br /> marked,and labeled/placarded,and are in all respects in proper condition for transport according to applicable International and national governmental regulations <br />