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HON-HAZARD0 SPECIAL WASTE-& AS ESTOS. MANIFEST : _rw: <br /> ,7 33 <br /> If waste is asbestos waste,:: Sections I,II,III and IV .: <br /> If waste is hM'asbestos waste;complete only Sections I,II and IIi. ��, 't; .`! <br /> - • <br /> MGBIL OIL =CORP _ �� Mobi-1eU9'-34,3 <br /> a.,.Generator Name:. + b Generating Location: <br /> �. Address 3 25. Gallow'':Rd. , '.IW210I 5{�0 E. Grarit line -.Rd. <br /> d• Address• <br /> Fairfax, VA 22D37 'i Tracy, <br /> e. Phone No.: 7 0 3)` 8 4 61-•3:0.0 0 k '€ n <br /> #. Phone No.: <br /> generating facility <br /> g <br /> If owner of the eneratin facili differs from theenerator,provide:t � <br /> g. Owner's Name: <br /> K.-Owner's phone No.:' <br /> i. BFI WASTE CODE C A Q 0 `5 �! J.0 7 •.7. 2 Containers DM-METALED UM ce` <br /> i. <br /> t' Q P- <br /> =Soil .Coffin r <br /> j.. Description_of Waste: gs` uantl i t! BA BAG <br /> M <br /> DRU <br /> N PE I9gG <br /> Un' o TY PLASTIC <br /> "wa'.'�+'�.rec_. ,�'r:`Srarn..,4. .: +"" ,4. . .'Z .,,4• ,.�- - -, , <br /> ", ✓ O '-OTHER 'ter _ <br /> GENERATOR'S CERTIFICATION: I hereby certify that the above named material is"not a hazardous waste as defined-by 40 CFR Part <br /> arty applicable state law, has been O <br /> Property.described;classified and packaged,-•and is in proper condttlon for transportation according to P .-POUNDS <br /> applicable.regulations:AND,If the waste Is a treatment residue of a previously restricted:hazardoua waste'subject.to the LBgd,Dieposal. Y =YARDS <br /> ResMdlons,I cert*and warrant that the waste has been treated in a000rdari with the*'luiremerds of 46 CFR Part 268 and Is no longer e4 M3�-'CUBIC METERS <br /> hazardous a e ed by qD CFR Part 261. 3_ ;:f <br /> �. AA ZOr r Y'17 <br /> "CUBIC.YARDS;. r -- <br /> i - Mobil 011 O -OTHER � <br />! Generator Authorized Agent Name Signature <br /> e x <br /> r :- 9 Shipment Dat <br /> py, iE p 7 <br /> 'TRANSPORTER I h TRANSPORTER ii <br /> a Naive- IWM INC.. <br /> #f. Name b z <br /> 150 AmeS AVe <br /> b'Address • as Address: r <br /> - ''Milpitas <br /> M pi tas, .CA ' <br /> t <br /> l .r hi rte.. <br /> c: Driver NarnerTtle:.' _ <br /> f. Driver NameTtle <br /> t C PRINTIIYPE <br /> fRINTMPE <br /> d Phone No', �_� j e: Truck' <br /> I, Vehicle License NoJState �' '� m.Vehicle License.No.7Stata: 6 <br /> Acknowledgement of Receipt.of Materials: ;, •Acknowledgement of Receipt'of Materials <: <br /> a <br /> DrHer Si re Sh ent Data - Driver's nature - Dere <br /> F -- <br /> a SiteName ': B 'IyasC© R[i. 'aci3:ty,�y c: Phone.No ( 0447 <br /> 4001 bio. Vasco<:Rc�. safe .as listed f qt <br /> b- Physical Address:' "l �' d ,Mailing Addvess �'x <br /> LiVert�ore, .CA 94550` r'4� m r $fir <br /> e:Discrepancy Indication Space: t u r <br /> -.l hereby certifyr that the above named.rnaterial has been'accepted and to the best of my knowledge the foregoing is true and accurate <br /> �f f� k <br /> �4 <br /> Or ArNrorized Agent . . - Signature. E. - - Receipt Date <br /> WRAP <br /> hippers s`,Name b Shippers's Phone No <br /> rF,.AT,,.ON: <br /> t'S`.Address. <br /> d ra .3 g '� { "F � i r 1' ,,,!"•5°3?�'�'AIf."e'wrr�.. y [wr <br /> �"'" �Cg�L 1.•} Y. r, rF"- "r s W�`� �..s � y��- '• pi' i <br /> 1 hereby declare that the contents of this consignmenbare fully and accurately described above by proper shipping name and are classified,pedcaged <br /> and labeiedlplacarded,and are in all respects In proper coridition for transport according to applicable international and national govemmental re <br /> gufatiorts <br /> a , <br /> rs's"Name&Tiffs: _ ___ <br />