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—`�'.�. �1r►! ^"° Ui <br /> .r <br /> �,.... <br /> is . <br /> L Sanitary,: ndfIj1`7' Sanifarry,Lanilfill� Landfill <br /> �a1601 Dixonanding Road 9999 S Au— <br /> s. <br /> tin I�pad90iSalley Ro ' tWMaB 'Aoa <br /> Pittsburg,CA 94565 Half Moon Bay,CA 940'19 Milpitas,CA 95035 Manteca,CA 95336 <br /> *Phone(925) 458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4244 <br /> Fax(925)458-9891 Fax(650)726-9183- Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATO <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRE S <br /> �S?:>V—PNXID;�-A J—Ua LT' <br /> CITY, STATE ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE O GLOVES O GOGGLES Q RESPIRATOR O HARq HAI <br /> Q TY-VEK O OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> * 717, <br /> GENERATORS CERTIFICATION i hereby certify that the above named rnatenai a not a hazardous <br /> wasio as defused by 40 CFR Part 261 or 86e 22 of the Caldonua code of regulations has been properly <br /> descnbed dassrfied and packaged and is in proper condition for transportation a-cording to applicable <br /> regulanon s AND,If the waste Is a treatment residue of a previousry restricted hazardous waste <br /> sub)W to the Land Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no lager a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> O DISPOSAL O SLUDGE <br /> O CONSTRUCTION Q WOOD <br /> ©DEBRIS -&&HER <br /> •SPECIAL WASTE <br /> GENERATING FACILITY <br /> mob <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBIS <br /> ADDRESS /R D 0.51 v <br /> CITY,STATE, ZIP <br /> PHONE END D MP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> i" D O ❑ D <br /> * 7 zz a <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate <br /> DISPOSE OTHER <br /> FIEMARKS O SOIL <br /> o CONSTRUCTION <br /> :W�H <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> SIGNATURE OF AUTHORI D DATE <br /> A EN ASBESTOS <br /> O WOOD <br /> O ASH <br /> * D SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:OOY.IN.THE DAY PRIORTO EXPECTED AlliRIVAL-ANY UNSCHEDULED LOADS ARE SUBJE( <br /> TO REFUSAL UPON ARRIVAL. ONGOI.(©, "ILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DA_Y^BEFOR <br /> ` , r . 'r^ S� 7� <br /> > - MANIFEST tlt,�°��k3�1'��%'., <br />