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NON -HAZARDOUS CIAL WASTE & ASBEOTOS MANIFEST a. Generator Name: c Jdress: s, If waste is asbestos waste, complete Sections I, II, III and IV. No. 606129 If waste is NOT asbestos waste, complete only Sections I, II and III. GENERATOR (Generator completes all of section I• w�- :t:, 2600 OHM Vii, RM ^ 350 SAN RAMM, CII: 94583 ehone No.: 510"823-9821 If ner of the generating facility differs from the generator, provide: b. Generating Location: d. Address: 10 r^.ASi' 12th STRM TRAM , C,A . f. Phone No.: `''1 I t — G ! Z — Z" � 0 g 'owner's Name: h. Owner's Phone No.: C A 405 O 1 2 79 5 - 029 10 TYPE I. IFI WASTE CODE Containers DM - METAL DRUM DP - PLASTIC DRUM NW ;»,per SOIL B BAG j. description of Waste: tr p, Quantit Units - No. TYPE BA - 6 MIL. PLASTIC BAG or WRAP T TRUCK m 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 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 longer M3 - CUBIC METERS a hazardous waste as defined by 40 CFR Part 261. / r / Y3 -CUBIC YARDS _ I J� — in. / /. / O OTHER >'U {c 1 � � C� -• Generator Aug orized Agent Namegnature Shipment Date II a. Name:'— b. ame:'_b. tdress:1, SAN JOSE, CA. /9/5132 C. iver Name/Title: 408- 729-0196 PRINT/TYPE d. Phone No.: e. Truck No.: I. thicle License No./State: knowledgement of Receipt of Materials. 9 %_ 1:77 ver Signature Shipment Date &MAIlik6TRANSPO_ING I TWI 2530 BERKYSSA ROAD, Sl'E 527 complete a -d: TRANSPORTER II FEB 91995 h. Name: i. Address: 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 S(Mion III IDESTINATION (Generator completes a -d, destination site completes e -f.) a�te Name: ` VASCO SANI17" T AN DF11L ph 571 G—=47— 3491 . b. 1ysical Address: 4001 X. VA_SCO ROAD LIVE4 RE, CA. 94-550 C. one No.. 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. r~�I Name of Authorized Agent Signature Receipt Date Sion IV ASBESTOS (Generator complete a -d, f, g, Operator' completes e.) Name: c. ^ erator's • Address: d. Jecial Handling Instructions and additional information: b. Operator's* Phone No.: OPERATOR'S CERTIFICATION: I hereby declare that the contents of this consionment are fully and accurately described above by proper shipping name and are classifies, baciw, marked, end labeled. and are In all respects In proper condition for transcon by highway accorc nq to applicable international and government regulations ern,or'< `Jame ', --t!a.