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-:r23 1 S n�M leo i �` 1641t•D on'L`aii ing'9t ad 9999 S'Austin Road_ <br /> 901�Ba1I ' RoadMan(eca,CA 95336 <br /> F istiurg';CA 94565 Hall,Moon�Bfi;CA"94,019 - Mdpta's.Ck95035° "�"' <br /> Phone(925)458-9800 Phone(6t0)�26-1819 Phone,`t408)945-2800 Phone(209)982-4291 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)'262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> ENERATO WASTE ACCEPTANCE NO. <br /> MAILING AD ESS _ <br /> CITY,STATE, P REQUIRED PERSONAL PROTPCTIVE EQ IPMENT <br /> PHONE 0 GLOVES O GOGGLES O RESPIRATOR 0 HARD HAT <br /> 0 TY-VEK 0 OTHER <br /> ' CONTACT PERSO SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> z zip, C) C� <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFA Part 261 or title 22 of the California code of regula0on3 has been properly <br /> described classified and packaged and is in proper condition for transportation a-cording to appkcable <br /> regulations AND It the waste la a treatment residue of a previousty restricted hazardous waste <br /> subject to the Land Disposal Restnctions I certify and warrant that the waste hes been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Pad 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ' O DISPOSAL 0 SLUDGE <br /> CI CONSTRUCTION R WOOD <br /> ❑DEBRIS %[3ATHER <br /> 0 SPECIAL WASTE lT��----- <br /> GENERATING FACILITY <br /> m6MTRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY,STATE,ZIP 2,ad <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> _ ❑ ❑ ❑ ❑ <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 /> EMARKS 0 SOIL <br /> DISPOSE OTHER <br /> O CONSTRUCTION <br /> FACILITY TICKET F_ DEBRIS <br /> 0 NON-FRiABLE <br /> /11 ASBESTOS <br /> SIGNATURE THORIZED ENT DATE <br /> ' � o woaD <br /> ASH <br /> " SPECIAL OTHER_ <br /> ,. r L r>r5; � rf.t,-,Jr.,.RL""H';<�ia._�+�•'�:+3'.r� <br /> SCHEDULING MU BE MADE PR 3 00 PM.THE nDAY PRIORTO EXPECTED ARRNAL•ANY UNSCHEDULED LOADS ARE SUBJE� <br /> TO REFUSAL UPO ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFOF <br /> MAIST <br /> GENERATOR COPY S;,,a 'UU,5/ic A ; <br />