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'� 7z1�4fr�h:irt�17�10�1 ?nF �MCiLli81fI3"+ ,na xtt �s�-J 1I@WDy lSt8E7�1 #{. r�afa waatu <br /> r:3ry, 4 'mt. t , u <br /> r �.� w w'' �' S�'+1,-„- ,7 <br /> Landfill-�t,�'; $mnitary t:antifll�' n " Sanitary landfill Landfill <br /> hs r �� i. <br /> 91al �siley Road;a ° ; "" =r _; 1231 tl San Mfec Noad` 1 S01 Dlxan Landing Road 'y99�9 5 Austin Rid <br /> Pittsburg;CA 94565 ', Half Moon Bay CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-429 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209) 982-1009 <br /> r <br /> NON-HAZARDOUS WASTE, ANIFEST <br /> GENERATOR <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRE S <br /> CITY, STATE,KIP REQUIRED PERSONAL PROTECTIVE E UlPMENT <br /> :1GLOVES ❑GOGGLES Q RESPIRATOR ❑HARD HAT <br /> PHONE <br /> Q TY-VEK Q OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT TITLE DATE <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material a not a hazardous <br /> waste as defined by 40 GFR Part 261 or title 22 of the California code of regulations has been properly <br /> described classified and packaged and is In proper condition for transportation a-cording to applicable <br /> regulations AND,If the waste is a treetruent residue of a previously restricted hazardous waste <br /> subtecl to rhe Land Disposal Restnctions t certify and warrant that the waste has boon treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ❑DISPOSAL ❑SLUDGE <br /> Q CONSTRUCTI1JWAy <br /> SPECIAL WAS <br /> GENERATINQ_ ILI Yr ' <br /> KI <br /> TRANS ORTE - NOTES VEHICLE LICENSE NUMBER TRUCK NIUM8£ <br /> ADDRESS O <br /> 12 <br /> CITY, STATE,ZIP t. ��'` '~ 10�$� <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DJRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> 4 CUBIC YARDS <br /> 1 hereby certify that the above named material has been ' <br /> accepted and#o the best of my knowledge the foregoing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate, <br /> - DISPOSE OTHER <br /> REMARKS o SOIL <br /> Q,CONSTRUCTION <br /> FACILITY TICKET NUMBER j [DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATYRE QF AUTHO IZED AZENT DATE <br /> ❑WOOD � r <br /> r <br /> Q ASH i <br /> ,y <br /> SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PHIORTO 3.00 P M THE DAY PRIORTO EXPECTED ARRIVAL!ANY UNSCHEDULED LOADS ARE SUBJEC <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE,DAY BEFOR <br /> A r°.. r�".tr � 'L %.—r+ef� �u �y}i}y�',irl3i' - ., MANIFEST 1f 5,214 <br /> }. t GENj,RATQR COPY r sa"'M:k +;x v ' -' �`,' ,^ r 4 - - <br />