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'�- 'w-i' 'F fm fteq�{.3PR+a �V ndfill ,Landfill <br /> S Ir�itary Landfil�� � iriltap, L:a 'd ill -. - ��!► <br /> Nr ,Sari Yr, 1 ,rtP <br /> i i, - z "tom r+ k'" ; 1 Road , 9999 S Austin Road <br /> ;� O jr alle"y <br /> Roo a: .",`,; .r 231_Sa ateo �oa�l y, , t 601rDixot}l4pc ri9 . <br /> � ��'" ' g 1 MI{ Inas,CA 95Q35 K=� Manteca,CA 95336 <br /> Pitts6re,CA 94565`` hlaif`Moon+Bay,Ca,_4Q 9 P Phone(209)982-4298 <br /> Phone(925)458-9800 Phone(650)'726-1819 Phone(408),945-2800 Fax(209)982-1009 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262--2$71 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> I GENERATOR WASTE ACCEPTANCE N0. <br /> & <br /> - <br /> MAILING ADDRESS <br /> ` CITY,STATE,ZIP !i ,d REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> '1 O GLOVES O GOGGLES O RESPIRATOR 0 HARD HAT <br /> PHONE <br /> O TY VEK O OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURE <br /> t <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR S CERTIFICATION I hereby Derby that the above narned material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the(: lWdonua code of regutations ties been properly <br /> described dassifed and packaged and�in proper condition for transportation a-cording to appbcable <br /> regulabons AND,it the wears Is a troatment residue of a pmvlousty resWeted hazardous waste <br /> subject to the Land Disposal Restrictions I certify and warrani that the waste has been treated to RECEIVING FACILITY <br /> Zcotdance with the requirernents of 40 CFR Part 268 and is no 10%Or a hazardous waste as defined by <br /> CFR Pan 261 <br /> WASTE TYPE <br /> •DISPOSAL Q SLUDGE <br /> Q CONSTRUC]_401r O WOP-11 <br /> Q DEBRIS <br /> O SPECIAL WASTE ^' <br /> GENERATIN9 FACILITY <br /> ♦ 41,q Mt ., }f <br /> TRANSPORTER_ NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS 22 Z42 444A J, <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR D9nVER JDATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> f <br /> I <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> S accepted and to the best of my knowledge the foregoing <br /> DISPOSAL METHOD (f0 BE COMPLETED BY LANDFILL) <br /> Is true and accurate -f <br /> DISPOSE OTHER <br /> solL <br /> REMARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZ D/iGENT DATE <br /> O WOOD <br /> A <br /> 1 DA`r-'�gznwLOTHEA <br /> SCHEDULING MUST BE MADE PRIOR TO 3.00 P.M THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJE <br /> TO REFUSAL UPON ARRIVAL ONPOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFOI <br /> MANIFEST 0 6�Z 9� <br /> a _ rn`_t <br /> :: <br /> _ `GENERATORaCOP„Y.`x"ti'.�•`' r, , r HI �;'��+ a ��� f1 <br />