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+ �vYfa+tld9 #uk_F^'! 1x},'X ,Va■liLQ��'� l.yfit Mla�li '... l4rYYi! !M}•°fi' <br /> 901RBail+3y Road `123�San MA ioa 16076lzon L`aMing Rbad 9999 S'Austin Road_ <br /> c` RitEsburg;�GA 94565 Ha1f,�Vloon�Ba ,' 9C 4.,019 MilpltMs,CA'95035' £"` Manteca,CA 95336 <br /> _'hone(925)458-9800 Phone(6t0)K6-181_9 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-HAZARDOUS WASTE MANIFEST <br /> ENERATO WASTE ACCEPTANCE NO. <br /> MAILING AD ESS w <br /> CITY STATE, P REQUIRED PERSONAL PROT CTIVE EQ IPMENT <br /> PHONE — UGLOVES Q GOGGLES Q RESPIRATOR Q HARD HAT <br /> 0 TY-VEK Q OTHER <br /> ' CONTACT PERSO SPECIAL HANDLING PROCEDURES <br /> SIGNATURE: OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR S CERTIFICATION I hereby certify that Ore above named matenat is not a hazardous <br /> waste as defined by 40 CFR Part 261 or litle 22 o1 the Caldorua code of regulations has been properly <br /> descnbed classified and packaged and is to proper condition!or transportation a-cording to applicable <br /> regulations AND It the waste to a ti eabrtent residue of a previoaaty restricted hazardous waste <br /> subject 10 the Land Disposal Restrictions I certify and warrent that the waste has been treated in y RECEIVING FACILITY <br /> aczordancs with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined b <br /> 40 GFR Part 261 <br /> WASTE TYPE <br /> ' Q DISPOSAL Q SLUDGE <br /> Q CONSTRUCTION ❑WOOD <br /> Q DEBRIS �pOTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY <br /> FACILITY <br /> j 3 <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER ° <br /> ADDRESS qNs <br /> CITY,STATE,ZIP L : <br /> PHONE _ / — END DUMP BOTTOM DUMP TRANSFER <br /> Ur ❑ ❑ <br /> ' SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL -FF(S) FLAT-BED VAN DRUMS <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 /> DISPOSE OTHER <br /> ' O SOIL <br /> EMARKS ❑CONSTRUCTION <br /> FACILITY TICKET DEBRIS <br /> Q NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE GF4kQTHORIZED ENT DATE <br /> � ❑WOOD <br /> ASH <br /> F CI SPECIAL OTH>rR <br /> 1 <br /> I <br /> t�` � ' <br /> SCHEDULING MU BE MADE PR 3 OO PM.THE DAY PRIORTO EXPI=CTED ARRtVAI.•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPO ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> "'�{s"t ya C;1 •.' r r rte" 4+'t w� z , I, � .c ay <br /> MANIF'Eic Sw T."# <br /> u,mx �' <br /> 12 <br /> �'y A ' <br /> -,as5 'An orf <br />