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�iiriir 9 j� LdillG3ili! ��flii r 6 ii51G71<11! mar ftary LatIGTI11 LBli1umi <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Roach 9999 S.Austin Road <br /> Pittsburg,CA 94565 Mali Nixon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4258 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)962-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING DR SS y <br /> 9 I <br /> CIT(,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT, <br /> LL !1 GLOVES /GOGGLES 0 RESPIRATOR /HARD HAT <br /> PHONE <br /> 7/125C!TY-VEK Q OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHO IZED AG ENT 1 TITLE for � :�L)T3 <br /> GENERATOR'S CERTIRCATJO :I hereby certify that the above named matertat is nota hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the Catifornia code of regulations.has been properly' <br /> descriged,classified and packaged,and is in proper ooni ition for transpertation a^Cordng to applicable <br /> regulations;AND,If the wast*Is a treatment raaktue ofd pravtoasty restricted hazardous wacle _ <br /> subiact to the band Disposal Reslr;ctions.l certify and warrant that the waste has been treated in .RECEIVING FACILITY <br /> accordance with the requirements of 40 CFA Part 266 and Is no longer a hazardous.wa.sta as defined by <br /> 40 CFR Part 261. - <br /> WASTETfPE: 5W in <br /> DISPOSAL U SLUDGE <br /> ❑CONSTRUCTION U WOOD <br /> *DEBRIS 0 OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1005 <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBEF31 TRUCK NUMBER <br /> v,r�,•,cc2 - �C IY 7'i e , <br />'l ADDRESS <br /> clTv, sTArE - <br /> e <br /> I PHONE END DUMP BOTTOM BUMP TRANSFER <br /> d 2 2 ❑ Q <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS} FLAT-SED VAN DRPMS <br /> 0 c 5 <br /> CUBIC YARDS <br /> E <br /> I hereby certify that the above named material has been <br /> accepted and t0 the best of my knowledge the foregoing DISPOSAL.METHOD: (TO BE COMPLETED BYLANDFILL) <br />{ <br /> Is true and accurate. <br /> I DISPOSE OTHER <br /> Q SOIL <br /> EMARKS <br /> Q CONSTRUCTION <br />$ FACILITY TICKET NUMBER i DEBRIS <br /> O.NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> Q WOOD <br /> 12 ASH <br /> f I - <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORT0 3:00 I.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE .SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> MANIFEST <br />