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NON-HAZAR64US SPECIAL WASTE &C3BESTOS MANIFEST <br /> If waste is asbestos waste,complete Sections 1,it,ITL and 1V No-512254 <br /> If waste is NQI asbestos waste,complete only Sections I 11 and III <br /> r +:x^s x„ ted.ai' �.�a <br /> tis ti� a �GENERATOR:� r�snofs <br /> Generator Name ARM PRC3 01=2 �PAtZY b Generating Location ARCO STATION V36020 <br /> C Address PCB S077 <br /> d Address 1.711 8, TOSENITF <br /> JNA PAM., CA 90622-5077 dam, Ch <br /> e Phone No (925) 299--U91 PAM IS3PPLE f Phone No XGA <br /> caner of the generating facility differs from the generator, provide <br /> Owner's Name ARCO PRCL'WIT COMPANY h Owner's Phone No sarm as I(e) <br /> BFI WASTE CODE C A 4 Q 5 10151 1 2 9 9 10121 O5 Q TYPEContainers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> B -BAG <br /> I Description of Waste t�3F'- RMJS SOIL, <br /> k Our tity [inns No TYPE BA -6 MIL.PLASTIC BAG <br /> KI <br /> or WRAP <br /> Of9 (� Q 1 T 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 UNITS <br /> any applicable state law has been properly described, classified and packaged and is in proper conddron 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 certity 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 1Xo-' ue t of ARCO PRkODUC7'S CI MPANY Y3 -CUBIC YARDS <br /> PATRICIA DILLARD/ DILLARD LAM, - � O -OTHER <br /> >f i <br /> Generator Authorized Agent Name Signature Shipment Date <br /> 7Tansporter t Complete a g. <br /> X17 <br /> If r _ � TRANSPORTER Generator comptete a-d, Trans Aer u coin <br /> TRANSPORTER i TRANSPORTER II <br /> Tie -) h Name <br /> Address n /2 ei =' i Address <br /> � J r <br /> f i <br /> Driver Name/Iltle 14 -4- r^r err �? ''��- I Driver Name/Title <br /> PRINTfrYPE ` r PRINT/TYPE <br /> thone No 'Al' / fns e Truck No y!E"i k Phone No I Truck No <br /> ehicle License No/State _ z 1'7 � G r m Vehicle license NoJState <br /> Acknowledgement of Receipt of Matertals Acknowledgement of Receipt of Materials Tu <br /> n <br /> Dmer S nati7re- Sfv ment Date Dinar 5 nature Shi ment Date <br /> CtIQl1 III r�$'K t OESTI NATION (Generator completes a-d,destination site completes ed) <br /> 3FI - VA7ZO ROAD SANITAUY 7 .!ID ILL (925) 147-0491 <br /> ate Name c Phone No <br /> 4 01 4. V;i`x) ' ^)`n 4,4)1 t'. Vr ica' 7Os* <br /> hysical Address d Mailing Address <br /> :% ;j F. ?t� ` Tt-MIT-70tt-7, ,.i- t, , 5(j <br /> Discrepancy Indication Space <br /> hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate <br /> r]?4 t J-, <br /> Pot Ott--3139r <br /> of Authonzed Agent Signature Receipt Date <br /> on W ASBESTOS (Generator complete a-d f g,Shipper*completes e) <br /> p <br /> pers's*Name b Shippers's*Phone No <br /> ohippers's*Address <br /> I Shippers%Special Handling Instructions and additional information <br /> RTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packaged <br /> ed and labeled/placarded and are in all respects in proper condition for transport according to applicable international and national governmental regulations <br />