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va"a 4yt Pa r L_Jr v.r..a.,...a aawaar,,F # 'r' •.�sww. a.-.. <br /> a X Y* e!x'ti a Y+v,+ K'r i f1 aw "t—^lgg 1r �a "' 3 ., ,.l_Jr • �.»_....... <br /> a; 'Sanitalryl l ci F!I Sani'tary,, 6011 ;" SanitaryiLanilfill Landfill <br /> 66+Bailey Flaad j, 12310�SW?y itaoaRoad.' 1601&on Landing Road 9999 S Austin R3 ad` <br /> Pittsburg,CA 94565 Half Moon Bay,Ck94099 Milpitas;CA 95035 Manteca,CA 95336 <br /> ,Phone(925) 458-9800 Phone(650)726-1819 Phone(448)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-HAZARDOUS WASTE MANIFEST <br /> IF <br /> GENERATO <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRE S <br /> S:� - <br /> CITY, STATE ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE O GLOVES ©GOGGLES O RESPIRATOR ❑ HARD HAT <br /> ❑TY VEK O OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> waste as defured by 40 CFR Part 261 or titte 22 of the Caldonua code of regulatwns has been properly <br /> described classdted and packaged and is in proper condition for transportatran a-cording to epplrcable <br /> regulations AND,if the waste to a treatment residue of a pr,wriousfy restricted hazardous waste <br /> subject to the Land Disposal Restrictions l certify and warrant that the waste fres been treated in RECEIVING FACILITY <br /> accordance wash the requirements of 40 CFR Pan 268 and mno longer a hazardous waste as deflned by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ❑DISPOSAL U SLUDGE <br /> O CONSTRUCTION O WOOD <br /> ❑DEBRIS -&THER <br /> O SPECIAL WASTE '�- <br /> GENERATING FACILITY C,--,T l <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMB <br /> ADDRESS PA <br /> f q4lp <br /> CITY, STATE, ZIP <br /> J <br /> PHONE END D MP BOTTOM DUMP TRANSFER <br /> ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) 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 <br /> is true and accurate DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS a SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NOM-FRIABLE <br /> SIGNATURE OF AUTHORI D A EN DATE ASBESTOS <br /> O WOOD <br /> O ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00�.]III.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUB+IE <br /> TO REFUSAL UPON ARRIVAL. ONGO[f tdfi.ILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY�BEFOR� <br /> � S°3� ..-. .k <br /> rl RCOPY s MAMFEST '� �"u, , <br /> µ`Vi -GENERATO a fi <br />