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f1?�)�E'Lir71 Qr1i T�rs� f 4� �1 a*ktris r-r xt ' 7U noway Islam-e - U rwouvalu <br /> - ` <br /> r..r• 2+r n t �+k+ak".3�a �''� h�- e�i-Rr1 ..4s v`} ���w�:$ ^�'� kt 5��,-„� �a�r7y y , + <br /> 'Landfill-1K, ,F` w anitmLy�Lan"clflt�, Sanital�/landfill Landfill <br /> 1231D San 1�Afr"Road'-`< " ; 1601fDizon Landing Road -'9999 S Austro Road <br /> Pittsburg;CA 94565 Half Moon Bay,CA 94019 Milpitas;CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(650)726-1819 ' Phone(408)945-2800 Phone(209)982-429 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209) 982-1009 <br /> NON-HAZARDOUS WASTE, ANIFEST :Y ' <br /> GENERATOR '' WASTE ACCEPTANCE NO. <br /> MAILING ADDRE S <br /> CIN, STATE,7,1P REQUIRED PERSONAL PROTECTIVE E UIPMENT <br /> ❑GLOVES Q GOGGLES Cl RESPIRATOR 0 HARD HAT <br /> PHONE <br /> 0 TY-VEK D OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR S CERTIFICATION I hereby ceruty that the above named materiel rs not a hazardous <br /> waste as defined by 40 CFR Part 261 or bile 22 at the Cabfomka coda of regulations has been property <br /> described classified and Packaged and is In proper con&bon for transportation a--cording to applicable <br /> regulations AND,if the waste is a heehnent residue of a previously restricted hazardous waste <br /> lk fUbJ9Ct to[Ile Lard(1i9 <br /> poaal Restnctions t certify and warrant that the waste has boon veated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 ends no tonger a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> Ll DISPOSAL Ll SLUDGE <br /> }Ol CONSTRUC;1C1' '' CQ Y}/ObEr <br /> SPECIAL WAS F_ . r f 17 ,ra } <br /> GENERATING_ [LfTYt ' w <br /> AM <br /> TRANS1PORTER-%P,,e NOTES VEHICLE LICENSE NUMBER TRUCK NUMBS <br /> ADDRESS fD <br /> CITY, STATE,ZIP �. / "� io2' <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR YIVER DATE ROLL OFF(S) FLAT-BE❑D VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> n-,P <br /> Yv <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and4o the best of my knowledge the foregoing DISPOSAL METHOD CFO BE COMPLETED BY LANDFILL) <br /> Is true and accurate,t <br /> DISPOSE OTHER <br /> EMARKS 0 SOIL <br /> ❑,CONSTRUCTION <br /> FACILITY TICKET NUMBS DEBRIS <br /> ❑ NON-FRIA81-E <br /> ASBESTOS <br /> SIGNATVREOFAUTHO IZED AGENT DATE <br /> ! o wood � r <br /> !r 4 ASH f <br /> Icy SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3.00 P M THE DAY PRtORTO EXPECTED ARRIVALtANY UNSCHEDULED LOADS ARE SUBJE( <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE,DAY BEI+OR <br /> i <br /> ' " +: r._ _ ..+ _ .�,.�k . .. + r{ ^.^.,,� r_ ._' k ` .,+�_'�'i<�f��.<�.. ' iii►irCCc.`-r.. ,z f�T_`A A iA:..,. <br />