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LJ neiier %.,anyon Lj ux mountain U Newby Island ❑ Forward <br />' Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <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) 982-4298 <br />' Fax(925)458-9691 Fax(650) 726-9183 Fax(408)262-2871 Fax(209) 982-1009 <br /> . NON-HAZARDOUS WASTE MANIFEST <br />' GENERATOR ansaPro orp WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> girt art- rive 1 —' 327$ <br />' CITY STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> bt LtslJls MO 8300t <br /> PHONE ❑GLOVES ❑GOGGLES Q RESPIRATOR Q HARD HAT <br />' <br /> Q TY VEK Q OTHER CONTACT PERSON <br /> an 1-tuft H SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> ., � <br /> Z�d <br /> GENERATORS CERTIFICATION I hereby certify that the above named material Is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been propory <br />' described classified and packaged and Is in Proper condition for transportation a-cording to applicable <br /> regulations AND,If the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Mposat Restrictions I certify and warrant that the waste has boon treated In RECEIVING FACILITY <br /> accordance with the requirements of 40 GFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br />' WASTE TYPE <br /> Q DISPOSAL Q SLUDGE <br /> Q CONSTRUCTION U WOOD <br /> Q DEBRIS Q OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> 4004 S El Dorado Stcrktorr, CA 9:5200 <br />' TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Manley 8, 66ins I rucking, Inc <br /> ADDRESS ?ff -3o <br /> 3896 El €r f-;reek Rd <br /> CITY, STATE,ZIP <br /> Sacrament-o-,_-CA 8 <br /> PHONE END RVMP BOTTOM DUMP TRANSFER <br />' 916 3P t-6864 ❑ <br /> SIGNATUPq OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> (J"17 . (a <br /> 15- M-L?3 <br /> CUBIC YARDS <br />' I hereby certify that the above named material has been 18 Yards <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 ❑ SOIL <br />' 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> [SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> Q WOOD <br /> 0 ASH <br />'4 1 Q SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 08 PM THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br />' GENERATOR COPY MANIFEST# 5 2 ' 2 3 <br />