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&C( Y ,SP.ECIAL WASTE & 6BESTOS MANIFESt'4!I t + .yam <br /> if waste Asbestos waste,complete Sections L II.W atnd IV �-No .-512,23,5 <br /> ��O ` <br /> L 111 <br /> It waste Is NQI asbestos waste,complete only Secft%I.A and ID lr •512,23,5 <br /> L 1 ' �Al b Generating LocationARM MT1015 fO 20 <br /> i. Address VW 5077 d Address AM B. 1'OORNM <br /> BUM PAM CA 9062.2-5077, Numme Ch <br /> i Phone No (9251 299-8891 Pte` SUpPLE- f Phone No U/A -- <br /> f owner of the generating facility differs from the generator,provide <br /> I Owner's Name AIaRW PRODUCTS COWANY h Owner's Phone No Sst as I(6) <br /> C A <br /> S19 09 9 03 067 �1= <br /> BFI WASTE CODE Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> NON-EAURDOUS SOIL B -SAG <br /> Description of Waste k Oua Units No TYPE BA -6 MIL PLASTIC BAG <br /> 010101 <br /> 0 0 WRAP <br /> T -TRUCK <br /> a I 1 0 -OTHER <br /> GENERATOR'S CERTIFICATION i hereby ce"that the above named materia!Is nota hazardous waste as calmed by 40 CFR Part 261 or UNRS <br /> any applicable state taw, has been properly described,classified and packaged,and is in proper oondhion for transportation according to P -POUNDS <br /> applicable regulations,AND,H the waste Is a treatment residue of a previously restricted hazardous mast object to the I and Disposal Y -YARDS <br /> fieshkAions I certify and warrant that the waste has been treated In aocordanoe with the requirements of 40 and Is no longer a M' -CUBIC METERS <br /> hazardous waste as defined by 40 CFR Part 261 truest ARCO PRIDIVIt ANY Ya -CUBIC YARDS <br /> • O -OTHER <br /> HER <br /> MELISSA KIRK/ DILLARD ENVIRON. � <br /> Generator Authorized Agent Name Sig Shipment gate <br /> TRANSPORTER I - TRANSPORTER II <br /> Dila TRUCKING, INC. `- - _ h Name — <br /> - <br />-L Name-- - - — - -- — <br /> POB -579 <br /> i. Address _ - i Address <br /> SYR04ia Q1 94514 -- <br /> .. Driver Name/Title - -- - - — - - - -- j Driver Name/Me - - - - <br /> pre PNarrlrYPE <br />-1 Phone No _�925) $50 - e--Truck NoY -- k.-Phone No - - — --I-Truck No —� <br /> Vehicle License NoJstate m Vehicle Uoertse NoJState <br /> Acknowledgemertt of Rec Materials 5 Acknowledgement of Receipt of Materials <br /> i n <br /> FTTT <br /> driverShYxywd Portrar nature Dffie <br /> L Site NameBFI - VASCO ROAD SANITARY LANDFILL C Phone NO (925) 447-0491 <br /> __ _ __ <br /> 4001 N. VASCO ROAD <br /> � Physical Address VASCO ROiAD d Mailing Address 4001 N. <br /> LIVERMORE, CA 94550 LIVERMORE, 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 accurate , <br /> JOB# 1007/110 <br /> r PO4 09-30336 <br /> Nemo a Auft&W Ager» sonetuie iPi tete <br /> L Shippers's*Name b Shippers's*Phone No <br /> Shippers%*Address <br /> I 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 classfiied, package <br /> narked,and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations <br />