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syr r '4''ti i <br /> rr_` �'�{'••. `:' �y-s ;.8"Y t,�' t '�+sem"% t' x - .��- <br /> _z'- VON-HAZARi US,SP'ECIALWASTE &C313ESTOS_MATAIFE ' <br /> ff Waste is asbestos waste,oorriplete Sections L U.Ell and IV 4 <br /> If waste Is Masbestos waste,complete only Sections i,H and M No. 512236- <br /> AV <br /> OEM <br /> ARM PROOFS OOil AN7f r'=sem <br /> Generator Name ARC90 $'L'ATIO[li #06020 <br /> b Generating Loeagon w .r <br /> c Address POB 5077 d Address 1711 tR_ lND -E—N-I'4'E — - <br /> IBUPA PARK, CA 90622-5077 HARTEM, Ch <br /> e Phone No (925) 299-8891 PAUL SUPPLE f Phone No N/A <br /> wrier of the generating facility differs from the generator,provide <br /> Owner's Name ARCO PRODUCTS MANY h Owners Phone No Same &a I(a) <br /> C 14 4 05 O5 4 2 9 02 067 �E <br /> BFI WASTE CODE Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> NON—HhZhRDWS SOM B -BAG <br /> Description of Waste k eluant units No TYPE BA -6 MIL PLASTIC BAG <br /> NOa o f 0 -OTHER WRAP <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 dassified and packaged.and Is In proper condrtwn for transportation according to P -POUNDS <br /> applicable regulations,AND,if the waste is a treabrient 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 CFA Part 261 at the ,tregtte f ARCO PRODUCTS CC*IPANY Y' -CUBIC YARDS <br /> � <br /> MELISSA KIR11T/ DILI.ARD ENVIRON. ! ' O -OTHER <br /> Generator Authorized Agent Name SQnattue Sh prru Date <br /> TRANSPORTER TRANSPORTER 11 <br /> DITAJMD TRUCKING, It4C. <br /> h Name <br /> POB 579 <br /> ti Address I Address <br /> BYRON, CA 94514 <br /> Dnver Name/ aide J ) Driver Name/Title - <br /> (925) 50 PniNT/rYK <br /> khone No a Truck No k Phone No I Truck No <br /> ehicle License NoJState 9---rll- __ m Vehicle License NoJState <br /> dcnowledgeme of Receipt of Materials Adcnowfedgement of Receipt of Materials <br /> In <br /> rxnrer spiot, I Date <br /> R <br /> Rite Name <br /> Hj:I — VASCO ROAD SANITARY LANDFILL c Phone No (925) 447--0491 <br /> 41701 N. VASCO ROAD 4001 N. VASO O ROAD <br /> r <br /> yslcal Address d Mafiing Address <br /> LIVERMOrZE, CA 94550 LIVERIOPE, CA 94550 <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 /> �-1 ,TOB# 1007/110 <br /> P0# o9-30336 <br /> dA v irei�g s�q�apna�re+ ^ ftoeV Dare <br /> Phippers's* <br /> i' `Y'Y -z„`-f!:Yk�nH�L7GSIVS ,.y �4.„,, ,,'s �:tri ; -'• " '” 'S r <br /> _lp <br /> ma <br /> pers's*Name b Shippersi Phone No <br /> Address <br /> hippers's Special Handling Instructions and additional information <br /> 71FICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classdied, packaged, <br /> ia ed,and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations <br />