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___"MGUS SPRC AL WASTE & ASBESTOS MANIFEST <br /> If waste is asbestos waste,complete Sections 1 II III and IV o. O <br /> If waste is NOT asbestos waste,complete only Sections 1,11 and III 1 N <br /> 0-5972 <br /> GENERATOR (Generator completes all of Section t) <br /> a Generator Name C, 1 YEA 0 S.A N[ X01 i)iu 9-42-5 <br /> 6 Generating Location <br /> c Address d Address -115 ,�ENjA-d1\ W)'.,T, CROSS S R :_: �pl,`k'j, <br /> .C1 ION CA <br /> e Phone No t Phone No <br /> If owner of the generating facility differs from the generator provide <br /> g Owners Name <br /> h Owners Phone No <br /> TYPE <br /> i BFI WASTE CODE �, 9 b7 s Containers DM-METAL DRUM <br /> DP -PLASTIC DRUM <br /> I Description of Wastek QB -BAG <br /> Quantity units No TYPE BA 6 MIL PLASTIC BA <br /> or WRAP <br /> LT TRUCK <br /> a 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 condition for transportation according to P -POUNDS <br /> applicable regulations AND,if the waste Is a treatment residue of a previously restrictedt}azardous waste subject to the Land Disposal Y -YARDS <br /> Restrictions !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 // % Y3 -CUBIC YARDS <br /> O -OTHER <br /> rator Authorized Agent Name � <br /> Gen / A <br /> ignature Shipment Date <br /> Section H TRANSPORTER (Generator complete a-d, Trransporter II c mp1ete-? <br /> TRANSPORTER11 TRANSPORTER II <br /> a ame ALLWAST=, f'k.A.kSPOR TA ION h Name <br /> b Address I`4 r 5 1,--A3'°S AVLI) OF <br /> I Address <br /> SA-N '"Bili' N, CA <br /> Felt-� i <br /> c Driver Name/Title , Ate`+ t !`f(� I Dnver Name/Titfe! <br /> - PRltYP X PRINTiTYPE <br /> d Phone No :Y Ii�1� — �_ e uck No k Phone No l I Truck No <br /> f Vehicle License No/State_ C me cle License No/State <br /> Acknowledgement f Receipt of Materials rA�knowledgement of Receipt of Materials <br /> g <br /> 1 - � � 1 � <br /> � <br /> n <br /> l9rrv�r I nature Sh merit Date Driver SI nature shipment Date <br /> Section III DESTINATION (Generator completes a-d,destination site completes e4) <br /> a Site Name ul 1'/�`7G`) .�,_ c Phone No <br /> b Physical Address u t 0- �'�, s-`' I (s!�'r <br /> d Mailing Address <br /> - xf r k, <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 /> f <br /> Name of Authorized Agent Signature <br /> Receipt Date <br /> Ann N ASBESTOS (Generator complete a d f,g,Operator'completes e) <br /> a Operator's'Name b Operators'Phone No <br /> c Operator's`Address <br /> d Special Handling Instructions and additional information <br /> OPERATOR'$CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classifie. <br /> packed marked and labeled and are lin all respects in proper condition for transport by highway according to aDphcabfe internatinnnl Rnrf nrn-rnmoni— I'+ <br />