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u ars+cr v4arsyvrr U VA Iy1UUMT11 LJ IVcWDy 1511111(1 rouWafU Sanitary Landfill Sanitary Landfill Sanitary Landoll Landfill r 50f'uilej Aoad • 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road Pittsburg,CA 94565 Half Moon Bay,CA 94019' " Milpitas,CA 95035 Manteca,CA 95336 Phone(925)458-9800 Phone (650)726.1819 Phone(408)945-2800 Phone (209)982-4298 Fax(925)458-9891 Fax(650)726-�IW Fax(408)262-2871 Fax(209) 982-1009 NON-HAZARDOUS WASTE MANIFEST GENERATOR WASTE ACCEPTANCE NO.�r Chevron 9. 0557 MAILING ADDRESS 3 — P.Q. Box 6004 CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT San Ramon CA 94583 0 GLOVES ❑GOGGLES ❑RESPIRATOR O HARD HAT PHONE 4 _ ❑TYVEK MOTHER Level D CONTACT PERSON SPECIAL HANDLING PROCEDURES: T m QQjon f( SIGNATURE OF AUTHORIZED AGENT/TITLE DATE GENERATOR'S CUMFICATION:I hereby Gorily that the above named material Is not a hazardous waste as do&*d by 40 CFR Part 261 or title 22 of the CaRfomla code of regulations,has been Property described.dasstFed and packagedAma,if the waste is a,and is in proper condition for transportation anpording to applicable fogwabonsubject 7w Land d Disposal Resu$:Uons,I oaruty and warrant trusitmant residue of a�thal l the wase has been icted =ytreated irlus ae� a000rdenoa with the requirements of 49 CFR Par 269 and is no longer a hazardous waste as defined by RECEIVING FACILITY 40 CFR Par 261. WASTE TYPE: U DISPOSAL ❑SLUDGE O CONSTRUCTION ❑WOOD a DEBRIS ❑OTHER ©SPECIAL WASTE GENERATING FACILITY X39 So. Center Street Stoc 7SP ORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER M Inc. (,AESS 950 AmeS Avenue CITY, STATE, ZIP Mi 1 ni tag , CA 95015 PHONE END MP BOTTOM DUMP TRANSFER — SIGNATURE OF AUTHORIZED.AGENT OR DRIVER DATE ROL -0F S FLAT-BED VAN S CUBIC YARDS I hereby certify that the above named material has been 1:20 CY accepted and to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) Is true and accurate. DISPOSE OTHER U SOIL EMARKS _ a CONSTRUCTION DEBRIS FACILITY TICKET NUMBER U NON-FRIABLE .ASBESTOS SIGNATURE OF AUTHORIZED AG DATE _ a wooD a ASH a SPECIAL OTHER SCHEDULING MUST BE ADE IOffRYO 3:00 RM.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCH�EILED LOADS ARE SUBJECTPR TO REFUSAL UPON A RIVAL..-ONGOING DAILY DiLIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. MANIFEST# 44406 e TRANSPORTER COPY.