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- NONHAZARDL US SPECIAL WASTE & r.;13ESTOS MANIFEST <br /> j r <br /> if waste is asbestos waste,complete Sections I II,)III and IV N 0. 51221? <br /> if waste is NQI asbestos waste,complete only Sections I,II and III <br /> a Generator Name ARM PRO)=S COMPANY b Generating Location ARCO STA'T'ION #06020 <br /> c Address pCe 5077 d Address 1711 3, YO.SEKITE <br /> RUIM PARK, Clk 90622--5077 KUfMM, CA <br /> e Phone No i 925) Z9,_8891 PAUL S Tim f Phone No "A <br /> If owner of the generating facility differs from the generator,provide <br /> g Owner's Name ARCO PRODUCPL C(WAM h Owner's Phone No same as I(e) <br /> ` C A 4 05 0 5 i 2 _ � 02 05 IJ <br /> s - TYPE <br /> BFI WASTE CODE Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> NM-HAZARDOUS SOILB -BAG <br /> f Desonpbon of Waste k uanti Units No TYPE BA -6 MIL.PLASTIC BAG <br /> or G O S Q 1 T -TRUCK WRAP <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 property 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 tl2P Iegtla_" •t of ARCO PRODLiCT CCWPAf3Y Y3 -CUBIC YARDS <br /> P'�I$S~ KIRK/ DILLARD FAIVIRCIN, ]HiO OTHER <br /> Generator Authorized Agent Name Signature - Shipment Date <br /> � <br /> r gar�sd9�,.�».�.�rn r�r <br /> �-.gym.. <br /> Sectloit ra ;A TRANSPORTER (Generatorpe a a. rrans iter coral to h ns � � �a a, „ <br /> TRANSPORTER I TRANSPORTER H <br /> DILL:Rll TRUCKING, INC. <br />-a Name ----- - - - - - - - - h Name - <br /> POB 57 <br /> b Address i Address <br /> HYRON, Ch 94 514 <br /> c Driver NameRitlef rr Q• �1 /� 1q7 /I-- __ f Driver Namefritle <br /> (925) 634-68 G PRINTf"E PRINT(rYPE —� <br /> d -Phone No - --- - -- - ---- -- e-Truck No 7"- - _ k-Phone No I--Truck No - <br /> f Vehicle License No/State --3/4 16 42 'L - -- m Vehicle License No/State <br /> Acknowledgement of Receipt of Materials Acknowledgement of Receipt of Materials <br /> g C� 'Ii s In <br /> Driver Signature Shipment Date I Driver Signature Sin ment Date <br /> SectlOn III- �= _�4,a DESTI NATION fGertierator coi> etes a dudes natro�site n�eses e-f) x °m <br /> D"_I ' .SCJ FcOAD ShjJ TrxY L r7DFILL (925) 447-0411 <br /> a Site Name c Phone No _ <br /> 4 .01 Ps. •v"mscc rr,AE A,-aI r:. +I Isco R 14: <br /> b Physical Address - d Mailing Address <br /> LIV!F.140 E, Cr �4 5,_ _ L1VTR?kJAc , C�e <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 /> -' :,o f 3^ <br /> f <br /> Name of Authorized Agent signature Receipt Date <br /> Section IV, ASBESTOS (Generator complete a-d,I,g Shipper*completes e) <br /> a Shippers's*Name b Shippers's* Phone No <br /> c Shippers's*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, packag <br /> marked,and labeled/placarded and are in all respects in proper condition for transport according to applicable international and national governmental regulations <br />