COMPLIANCE INFO_1985-1998 - Laserfiche WebLink

Home Browse Search

EWA: i NI • Igaxi= If waste is asbestos waste, complete Sections I, II, III and IV. No. 60613P If waste is NOT asbestos waste, complete only Sections I, II and III. ti0f1;, I. - GENERATOR (General complates an of Section i PACIFIC BELL a enerator Name: b. Generating Location: c c ddress: 25170 OKUM RK 2EDc: �0 d. Address: 10 FEAST 12th STREET e ' SAN Ril C2i. _ 94583 TRACT, CA. e hone No'.- 514-823-9821 If owner of the generating facility differs from the generator, provide: Phone No.: q�� " 9 % `- "Z 4 i` g wner's Name: h. Owner's Phone No.: TYPE i. BFI WASTE CODE C A 0 5 0 1 1 2 1 0 9 1 ::1R] Containers DM - METAL DRUM DP - PLASTIC DRUM NON OCIS SOIL B BAG j. escription of Waste: 'k. Quantity units No. TYPE BA - 6 MIL. PLASTIC BAG WRAP T TRUCK rF - I/P I FTE O O - OTHER ENERATOR'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 properly described, classified and packaged, and is in proper condition for transportation according to P -FOUNDS plicable 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 treated in accordance with the requirements of 40 CFR Part 268 and is no longerM3 - CUBIC METERS hazardous waste as defined by 40 CFR Part 261. Ys - CUBIC YARDS _ t _ O OTHER L0 12 Generator Authorized Agent Name Sure Shipment Date S 4jon II_ TRANSPORTER (Generator complete a -d; T°=.O it wrraplateil ) a. ame: b. ddress: TTtt2530BERR , STE 527 b Iddress:? SAN JOSE, CA. 95132 c: river Name/Title: PRINT/TYPE d. Phone No.: 448— 7`�}-019Fi e. Truck No.: a f. ehicle License No./ State: cknowiedgement of Receipt of Materials. Signature _ � I Shipment Date TRANSPORTER II h. Name: I. Address: I. Driver Name/Title: PRINT/TYPE it. Phone No.: L Truck No.: in. Vehicle License No./ State: Acknowledgement of Receipt of Materials. n. Driver Signature SAtion III f DESTINATION (Generator completes a -d, destination site completes el VASM SANITARY IllilM 510-447-0491 a: ite Name:N b. hysical Address: ♦ � , .}� . e , fa c. Phone o.. d. Mailing Address: Shipment Date e iscrepancy Indication Space: I 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 Autnoraea Agent Signature Receipt Date tion IV ASBESTOS (Generator complete a -d, f, g. Operator° a.Tioerator's ` Name: c."`perator's ` Address: d. pedal Handling Instructions and additional information: b. Operator's* Phone No.: OPERATOR'S CERTIFICATION: ! hereby declare that the contents of this cons gnment are fully and accurately described above by proper shroping name and are classified. p - o. marKed. and taoelec. _no are In all respects in proper condition for transccrt cv hignwav according to applicable international and government regulations.