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r; IG`1�4ti11yV11' 6 ^ � �,,��}'-VJl7'IYM1<JY� 11 q }�'. +Zz�l \Olr/Yy Iillasstt}:e U ■'Vs f1Y�.�1; <br /> aet x x 1 y n Y r't',r tin <br /> "ems�.���xi�.I x>•3'�' .t,YG�.�.'�4. _ +' q"`5 <br /> ,``: ,;�itaryLandflli. ;���' SatiItaryrLandfil �n` �� SanitaryLandfill Landfill <br /> y �"r901 Bailey Road - 1231Q San Mateo Road 1601 Dixon Landing f load 9999 S kustm Road <br /> Pittsburg,-CA 94565 A Half Moon Bay, CA 94019 t Milpitas;CA 95035 Manteca.CA 95336 <br /> phone(925)458-9800 Phone(650)726-1819 Phone 4011)1145,2800 Phone(209)982-429 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)1982-1009 <br /> " NON-HAZARDOUS WASTE MANIFEST <br /> GENERftOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> ' CITY,STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE U GLOVES 0 GOGGLES U RESPIRATOR IR HARD HAT <br /> 0 TY VEK 0 OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> * 7/y7141 <br /> GENERATOR S CERTIFICATION I hereby cerbty that the above named material ts not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations has been properly <br /> described" <br /> lassifiod and packaged and to in proper condition for transportation a-cording to applicable <br /> regulaborksAND,If the waste to a treatment residue of a previously restricted hazardous waste <br /> subject to the Lard 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 re no torpor a hazardous waste as defined by <br /> ' 40 CFR Pert 241 <br /> WASTE TYPE <br /> O DISPOSAL U SLUDGE <br /> Q CONSTRUCTION O WOOD <br /> ' O DEBRIS THER <br /> D SPECIAL WASTE <br /> GENERATING FACILITY <br /> v a <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY, STATE,ZIP /Z_tA 13 <br /> J <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROL -O F(S) FLAT-BED VAN DRUMS <br /> e * <br /> '7/7 a U <br /> j CUBIC YARDS <br /> I <br /> ' 1 hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foreg lad) DISPOSAL METHOD (TO BE COMPLETED 8Y LANDFILL) <br /> Is true and accurate (f/,V <br /> DISPOSE OTHER <br /> ---"' 0 SOIL <br /> REMARKS <br /> Q CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER <br /> , r ONON-FON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZ D AGENT DATE <br /> ❑WOOD <br /> U ASH <br /> O SPECIAL OTHER Pte^A <br /> SCHEDULING MUST BE M PRIORTO 3.00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL ANY UNSCHEDULED LOADS ARE SUBdE <br /> TO REFUSAL UPON AR VAL ONGOIWG DAILY DELIVERIES OUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFOI <br /> �' ,....��.�� ���� •{,. _ _ . . MnNs1• ` ��6 5230'-- <br />