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NON-HAZAR;AYUS SPECIAL WASTE A'q TOS MANIFEST <br /> w <br /> 12ffwaste is asbestos waste,complete Sections 1,IL III and IV. III. - -N 0. 61144.9 <br /> If waste is NOT asbestos waste,complete only Sections 1,11 and <br /> L) <br /> a Generator Name: ARCO PRODUCTq C WPANV b. Generating Location: ARM QTATTQN *nn5g5 <br /> D- Address PnR Sn77 d. Address: Fl nn N BO qq <br /> BLMNA PARR, CA 90622-5077 sTnrx-MN CA <br /> e. Phone NO.: (925) 290RR91 PART suppT F f. Phone No.:— N/A <br /> If owner of the generating facility differs from the generator,provide: <br /> g. Owner's Name: AR(Yl PRnr171Mq TYVdPAhV h. O��IftWne�f'S_PI�hOnIa No.:. Camc as T(o) <br /> L —� <br /> C 4 5 <br /> i. BFI WASTE CODE 9 0 9 7 DP -PLASTContainers DM-METAL DRUM <br /> IC DRUM <br /> _ No. TYPE B -BAG <br /> j. Description of Waste: NnN_pp�ARmt1a ¢nTr k. Quanto � � m OA -6 MIL.PLASTIC-OTHER WRAP BAG <br /> ll <br /> 1 111 A el <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 property described, classified and packagetl, and is in proper condition for transportation according to p -POUNDS <br /> applicable regulations;AND,H the waste Is a treatm t resldu of a preglou'sly restricted hazardous waste subject to the Land Disposal Y -YARDS <br /> Restrictions,I certify and warrant that the waste has en treated n a Monne witti theirequirements of 40 CFR Part 266 and is no longer a M' -CUBIC METERS <br /> na;argous waste as defined by 40 CFR Pan 261. o Y' :OTHER YARDS <br /> 6 �L n th - equest,bf'ARCO 8 O -OTHER <br /> 6T r LJoFrfz ge RWg.\ Signature Shipment Date <br /> :TRANSP,ORTER'(Generator completead�,.7rermivr10r'.�( mp�etehg-7f <br /> TRANSPORTERI TRANSPORTERII <br /> a. Name: DILLI_RD TRUCKING, INC, It. Name: <br /> b. Address: POB 579 1. Address: <br /> BYRON, CA 94514 <br /> c. Driver Name/T-i le:_ _ j. Driver Name/rte: - <br /> PRINr/rYPE PRIWrrYPE <br /> d. Phone No.: 925-634-6850 (�a. Truck No.:_ k. Phone No.: I. Truck No.: <br /> I. Vehicle License No./State: �) 07.16 Z ( m.Vehicle License No./State: <br /> Acknowledgement of R!q?iptof Materials. Acknowledgement of Receipt of Materials. <br /> 9 <br /> -Z Z n. <br /> Dri,WS' SIJ Date Driver Si r>ature Shi meat Date <br /> iIT <br /> DESTINATION '(Gereatorcompletese3y . mp "„ •, "� <br /> a. Site Name: B11I - VASCO ROAD SA14ITARY LANDFILL c. Phone No.: (925) 447-0491 <br /> b. Physical Address: 4001 N. VASCO ROAD d. Mailing Address 4001 N. VASCO ROAD <br /> LIVERMORE, CA 94550 LIVF.RMORE, CA 94550 <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 /> - 'L-T,�-�--1 JOD?1 1007-128 <br /> I. PO# 09-31515 <br /> Norrie of Autl o izetl Agent Signature Receipt Date <br /> SectiOh IV_` 'e t' ASBESTOS (Genera or wmplete a d;t,g,shy rim hple es e:) <br /> a. Shippers's-Name: b. Shippers's-Phone No.: <br /> C. Shippers's*Address: <br /> d. Shippers's Special Handling Instructions and additional information: <br /> CERTIFlCATION: I hereby declare tltat ife artterris d this rnrsigrxrent are fully and accurately descdbed above by proper shipping rare and are classified, Packaged <br /> rteA<ed,aril labeled/placarded,and are in all respells in proper condition for transport axording to applicable international and national governmental regulations. <br />