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r <br />NOWHAZARDOUS'IrCIAL WASTE & ASBE*TOS MANIFEST <br />If waste is asbestos waste, complete Sections I, II, III and IV.® 1 <br />If waste is NOT asbestos waste, complete only Sections I, II and III. • <br />606 <br />GENERATOR (Generator completes an of section <br />a. Generator Name: PACIFIC BELL b. Generating Location: <br />c ddress: a 2500 ' mit 21M0 <br />d. Address: <br />S uv AUVIL , CA. 134583 TRACY/;/ <� c, C <br />%A. <br />f. Phone No.: / 7, <br />10 FAST 12th as <br />0J <br />e hone No.: 51G-922-9321 <br />lfnvner of the generating facility differs from the generator, provide: <br />g. Owner's Name: h. Owner's Phone No.: <br />TYPE <br />]LI WASTE CODE O 1 121-07 9 50 1219111 onta 0 Containers DM - METAL DRUM <br />DP - PLASTIC DRUM <br />j. ascription of Waste: HAZARDOUSAIM B -BAG <br />k. Quanti units No. TYPE BA - 6 MIL. PLASTIC BAG <br />or WRAP <br />iIT <br />/ T -TRUCK 1 <br />•::.'�'�-. :_ t O -OTHER <br />ENERATOR'S CERTIFICATION. I hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Part 261 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 />plicable regulations: AND, If the waste is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Y -YARDS <br />astrictions. I certify and warrant that the waste has been treated in accordance with the requirements of 40 CFR Part 268 and is no longer Ms - CUBIC METERS <br />a hazardous waste as defined by 40 CFR Part 261. ; / Y3 -CUBIC YARDS <br />`.-'Y �^J 1 ,'< �,! ; �.,• '-=?�.L../-f^ ; ?l � � !� c; O -OTHER <br />'"generator Authorized Agent Name aignature Shipment Date <br />I <br />a. Name: _ <br />b. dress: <br />$• TRANSPORTER I <br />TRUMCM <br />2530 BERRYESSA RQAD, SM 527 <br />SAN JOSE, CA. 95132 <br />Aver Name/Title: <br />^�729-0196PRINT/TYPEone No.: "�— e. Truck No.: <br />I. thicle License No./State: <br />knowledgement of Receipt of Materials. <br />–•t ��. �r--- <br />g' — <br />Signature <br />III <br />Generator complete ad; <br />C <br />Shipment Date <br />DESTINATION <br />VASM SANITARY LANDF311 <br />a. to Name: <br />b. ysical Address: <br />' !til � iii! • ! <br />LPL , CA. 94550 <br />e. screpancy Indication Space: <br />TRANSPORTERII <br />h. Name: <br />i. Address: <br />L <br />j. Driver Name/Title: <br />PRINT /TYPE <br />k. Phone No.: I. Truck No.: <br />m. Vehicle License No./ State: <br />Acknowledgement of Receipt of Materials. <br />n. <br />Driver Signature <br />completes ad, destination aft <br />W, <br />c. Phone No.: 510-447-0491 <br />d. Mailing Address: <br />I I I —L_I I <br />Shipment Date <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 />me of Autnonzed Agent Signature J Receipt Date <br />m iv <br />rator's ° Name: _ <br />rator'sAddress: <br />ASBESTOS <br />rterattx complete ad, f, <br />• completes e.) <br />b. Operator's' Phone No.: <br />d. Rectal Handling Instructions and additional information: <br />O—PERATOR S CERTIFICATION: I hereoy declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified. <br />pacKee. rnarKed. and labeled. and are m all respects m proper condition for transport by ntdnway accoraind to applicable international and government regulations. <br />NINE <br />