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US I�CIIISI Y�1lylifl'sq a:'4 tJI��JJ["IY1V41>EI 11I{+ LJ 11CCWWy 1�1i><114 F crus a*�s� <br /> �x c,�a�ss �� w 44'- Sawa W, rig r '� 74= _ 'z` r�1 i <br /> 'S Landfill <br /> Sanitary]Landfill's t F Sanitary Landfill - Landfill <br /> �n �.. <br /> 901 Ba 1WRoad f t23'&San Malleo Roald 1601 Dixon Landing Road 9999 S Austin Roe <br /> Pittsburg,CA 94565 Haff 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)982-42 <br /> Fax'(925)458-9891 Fax(650)726-9183 }} Fax(408) 262-2871 Fax(209)982-1009 <br /> NON-HAZARD011i WASTE MANIFEST <br /> GENERATQFh <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS I <br /> r <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQ IPMENT <br /> PHONE ❑GLOVES ' Q GOGGLES U RESPIRATOR 0 HARD HAT <br /> Q TY VEK 0 OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> -)/7 <br /> GENERATORS CERTIFICATION I hereby certify that the above named matenal w not a hazardous <br /> waste as defined by 40 CFR Part 261 or utle 22 of the Cablomia code of regulations has been properly <br /> described classified and packaged and is in proper condition for transportabon a-cording to applicable <br /> regufattone AND.If the waste Is■treatment residue of a previously restrloted hazardous waste <br /> subject to the Land Disposal Restnctlons I certdy and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the ragrarements 0140 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> O DISPOSAL 0 SLUDGE <br /> Q CONSTRUCTION Q WOOD <br /> •DEBRIS .D THER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMB <br /> ADDRESS v 1 75V <br /> CITY, STATE,ZIP44 7'4 � , <br /> I <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROL FF(S) FLAT-BED VAN DRUMS <br /> 1/n L4 <br /> CUBIC YARDS <br /> 1 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 /> REMARKS O SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE A1.15MORIZED AGENT DATE <br /> ❑WOOD <br /> U ASH <br /> Q SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3.00 P.M THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADSARE�JBJE <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MIST BE SCHEDULED WITH THE LANDFILL THE DAY <br /> MFEST i 1-6t211 ANI1 <br /> v h. 11'F <br /> GENERATOR COPY M " ` <br />