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i•3 ��t yV 'r4- z rr� `���Ce s:m�c a-3 _-1 T' y > r �l F VV"I%.a <br /> n(�Iw VX IM I �# 'k' si',�"iz � `�LJ n�WO �« Br�Q � Land <br /> �y+s. E� SSS-ter` ' ,^ ' 3�u i F �*lA14T -�'yt} v en ,�r, i; z � w r `4y "'S«Yr'« is'G s«" a Y_ Pili <br /> ' �rSat� Lary,L;Mdfill , mSanIt0ry,,LandfiN r ;' $r_ g Sanitaryk Landfill � '' _ <br /> t` .t,�, zx i e .«rEwr4 w rah, .r.,' .,a v` f x ""< .to ier'r�`s` a <br /> t' 9p3al,e�r123104San5i�lateo Road '"h`1601 DlicorrLandfng'Road 7 9993 S Aelstln Road <br /> PittsbAurg, 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)982-4298 <br /> Fax(925) 458-9891 - Fax(650) 726-9183 Fax(408)262.2871 Fax(209)982-1009 <br /> NON-H ARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS 1 _ / <br /> CITY, STATE, ZIP L REQUIRED PERSONAL PROTECTIVE QUIPMENT <br /> U GLOVES O GOGGLES O RESPIRATOR 0 HARD HAT <br /> PHONE <br /> 0 TY-VEK U OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> rJ <br /> GENERATOR S CERTIFICATION I hereby certify that the above named mstenal is not a hazardous <br /> waste as defined by 40 CFR Part 261 or bile 22 of the California code of regulations has been property <br /> described classified and padraged,and is in proper condrhon for transportation a-cording to applicable <br /> regulations ANO,If the waste is a treatment residua of a previously restricted hazardous waste <br /> subject 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 longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> U DISPOSAL U SLUDGE <br /> 0 CONSTRUCTION U WOOD <br /> ❑DEBRIS �R <br /> U SPECIAL WASTE <br /> ENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS Q <br /> /l <br /> I <br /> CITY,STATE,ZIP <br /> �� <br /> PHONE END DU BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> * iL <br /> CUBIC YARDS ` <br /> 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 /> 0 SOIL <br /> REMARKS <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATU E OFAUTHORIZED GENT- DATE <br /> O WOOD <br /> AlSil <br /> 7k P L OTHER = <br /> SCHEDULING MUST BE MADE PRIOR TO 3 00 P M THE DAY PRIORTO EXPECTE6 ARRIVAL a ANY UNI 6d EDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY,BEFORE <br /> c .. �+ <br /> MAN, <br /> FEST «', 2`arrt� . <br /> d, { <br /> ,z ' - - GENERATOR COPY,- r « K"'e - <br />