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xr ✓Jb-177b Ubezy ID: IWM, INC. P.02 <br /> 1 <br /> NON-HAZARDS SPECIAL WASTE & A..,BESTOS MANIFEST <br /> if waste is asbestos waste,complete Sections 1,it III and Tv. �� <br /> If waste is NOT asbestos wase,compete only Sections t,9 and Im No. <br /> Section I GENEflATQA (Geinera!or coffoetey as or <br /> r . <br /> t. Generator Name: Nestle' ::St':, Inc. b. Generating Location: Port Stockton :"cot's <br />:. Address 800 ii 3raaci Blvd. d. Addreiss: 4343 Freront St <br /> Gl:rnaaie, CA 91203 Stocktcn, C <br /> S. Phone No.: 818-54 01-594 8 f. Phone No.- <br /> f owner of the generating facility differs from the generator,provide: <br /> I. Owner's Name: h, Owner's Phone No.: <br /> 8FI WASTE CODE A `� ✓ © L9 7- - M'! & 1 0 1 U R Containers DM•METAL DRUM <br /> OP -PLASTIC DRUM <br /> Description o!Waste: S O 11 Cuttingsk Quant' u t& No. TYPE BA -BAG <br /> Mil.PLASTIC BAG <br /> • a WRAP <br /> 1 0 Y T -TRUCK <br /> — - - — -- 0 -OTHER <br /> 13ENERATOR'S CERTIFICATION: I hereby certify chat the above named materiae is not a hazardois masts as defined by 40 CFA Part 251 or UNITS <br /> any applicable slate raw, has been property *wttt?sd, da"fied and packaged, and is in proper condition for Iransportaton accordurg m P -POUNDS <br /> applicable regubdiona;AND,It the wesa is a treatrnent reatdue of a previously restr&Wd h—rdcus rade sublet/to the Land Disposal Y •YARDS <br /> Aeetrielions,I certify and warrant that the waste has been treated In eoeortAvve with the regalremerlts of 40 CFR Part 208 and Is no longer a M' -CUSIC METERS <br /> hazardous waste as defined by 40 CFA Pan 261. Y* -CUBIC YARDS <br /> Y La LEasV pN 8f 4641-7- '0 Ar O •OTHER <br /> Generator AbIhodfad Agero Name Signature rl Shipment Date <br /> p�ryp�p .. <br /> 58lttOfy.II *t RANSPORTEp Qanetatar <br /> II eM lrm •; <br /> TRANSPORTER I TRANSPORTER Il <br /> Name: I'WM, Inc. h. Name: <br /> Address: 950 Azleo Ave. i. Address: <br /> Milpitas, CA 95035 <br /> Driver Name/Title: J, Driver Name/Title: <br /> D <br /> Phone No.: 0 8-9 4 2-$9 . Truck No.: J jr ��� k. Phone No.: � . Truck No.: <br /> Vehicle license No./State: m.Vehicle License NoJState: <br /> Acknowledgement of Receipt of Materials. Acknowledgement of Receipt of Materials. <br /> f_ /�.L( �.. � � © `7 n• t co <br /> Driver S nature 8hi O.ts DMer 8 etUe te <br /> ..,; '... r , 4 •tit:. ,... .. .. ... If 11• w,,l '<h %.1 }l *'y 'r IfM <br /> �.:..�E.'iYINaTK3N (Gerteutawtrialeoass-ctr: tiistigr�rl k,>L;„ s•` <br /> Br I-VasCc l ----- ------- •-5'i-t}--+i�'�=t��4 t_ _ �:.-_ --- - - - - - <br /> Sits Name; c. Phone No.- <br /> Physical Address: 4001 11 'v a S C o R d. d" Malang Address Same <br /> Livermore, CA 94550 <br /> Discrepancy indication Space: <br /> I hereby certify that tete above named material has been accepted and tv the best of my knowledge the foregoing is true and accurate. <br /> Name of Aatrorix"Agus S.B^eture Qvav;vt n <br /> 319cuofl IV ASBESTOS {Geta seer ax*wl�a e,t.9;Operaooet cotYtp s e r <br /> Operator's'Name: b. Operator's'Phone No._ <br /> Operator's'Address: - — <br /> Special Handling Irtstnictions and additional information, <br /> PERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper Shipp ng name and site dassrfo_d, <br /> 3cked.marked,and labeled,and are in all respects In propercondition tortransport by hVrWay wording to applicable international aril gavemment regulations. <br /> TOTAL P.02 <br />