COMPLIANCE INFO_1985-1998 - Laserfiche WebLink

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A • !' AlqiiMWI ZMJ1111 11111111 ! -1 - i A If waste is asbestos waste, complete Sections I, II, III and IV. NO. If waste is NOT asbestos waste, complete only Sections I, II and III. Plow • s GENERATOR (Generawwritplotesal of Section 1) , a. Wnerator Name: c. dress: ' , SAN RAMON, CA: '=XA594411; r ' ione No 510-823-9821 0 111140 v, #01 b. Generating Location: v CUMUM RAMN, RK. 2ED50 d. Address: CT, CA - f. Phone No.: If owner of the generating facility differs from the generator, provide: g. ner's Name: h. Owner's Phone No.: TYPE i. BFI WASTE CGDE C A 0 5 EiL2 7[9L5 [o]2J.9 1 0 L I Containers DM - METAL DRUM OP - PLASTIC DRUM B - BAG NMI SOIL Quanti units No. TYPE BA - 6 MIL. PLASTIC BAG j. scription of Waste: k• or WRAP a O D mT TRUCK tj� O- OTHER NERATOR'S CERTIFICATION: I hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Part 261 UNITS any applicable state law, has been property described. classified and packaged. and is to proper condition for transportation according to P -POUNDS applicable regulations: AND, if the waste is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Y - YARDS Restrictions. I certify and warrant that the waste has been trgated in accordance with the requirements of 40 CFR Part 268 and is no longer Ma - CUBIC _ CUBIC METERS azardous waste as defined by 40 CFR Part 261. , / YARDS O OTHER -- !i" i Q Ct .� 1 l - t ` /i� sit; '• �t'l� L L" Shipment Date Generator Authorized Agent Name Signature P - Transporter I complete e g tion II TRANSPORTER (Generator Compote a -d' Transporter tt complete t> n n III. TRANSPORTER I • C Q 1�i a a ame: +% 2530 A , SPE 527 b. ddress: 14 =y JCsE, G_ 95132 c xiver Name/Title: V ' -!C3_7, 29L-Olc)i PRINT/TYPE /7 d. Phone No.: e. Truck No.: Jehicle License NO./ State: r r cknowledgement of Receipt of Materials. river Signature. _ __. Shipment Date h. Name: i. Address: TRANSPORTER II FEB9'995 I. Driver Name/Title: PRINT/TYPE k. Phone No.: I. Truck No.: m. Vehicle License No./ State: Acknowledgement of Receipt of Materials. n. Driver Signature tion III - DESTINATION (Generator completes a -d. destination site completes e -f.) VASCO .]kN lTITt R LAND1711 r 510-447�A91 a 'ite Name: - c. Phone No.: b. hysical Address: l ff tiA <a ! d. Mailing Address: Shioment Date iscrepancy Indication Space: 1 hereby certify that the above named material has been accepted -and to the best of my knowledge the foregoing is true and accurate. Name of AuthoriaeC Agent Signature Receipt Date 4jon IL' ASBESTOS (Generator complete a -d, t, g, Operator' completes e.) Name: cperator's ` Address: d pecial Handling Instructions and additional information: b. Operator's* Phone No.: OPERATOR'S CERTIFICATION: i hereby declare that the contents or this cons cnment are fully and accurately described above by proper shipping name and are classified. -Weo. marked. and ioelec. and are in all respects in proper condition for r-ansoc,7 pv nignway according to applicable international and government regulations.