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sanitary Landfill Landfill •." �tr'vurrta,rt Lt11dCYTu J010rru g <br /> � � a-6r1t+1f�rd? <br /> 901 BaileyRoad T% San Lary Landfill ,Sanitary Landfill Landfill <br /> 28972 fin Butte Road <br /> Pittsburg, CA 94565 12310 San Mateo Road 601 Dixon Landing Road 9999 S. Austin Road <br /> Phone (925)458-9800 Corea.._' _R 97330 Half Moon Bay, CA 94019 <br /> Phone (541) 745 2018 Y Milpitas, CA 95035 Manteca. CA 95338 <br /> Fax(925)458-9891 Fax(541) 745-3826 Phone(650)726-1819 Phone (408) 945-2800 I <br /> 'Fax 650 726-9183 Phone{209 °82-,298 <br /> ( ) Fax (408)262-2871' Fax (,^_09) c87.-1409 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> MAILING ADDRESS D WASTE ACCEPTANCE NO. <br /> NG <br /> 991 <br /> CITY, STATE, ZIP <br /> Traoy.CA OTECTIVE ECtUi17fV11El'ti)-_F j <br /> PHONE •GLOVES ❑ GOGGLES ❑ RESPIRATOR :b HARD FIAT <br /> CONTACT PERSON Ct TY-VEK 121 SAFETY VEST <br /> Anne(L y SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLr* DATE <br /> -waste a define CERTIFICATION:I hereby certify that the above named material is not a hazsWous <br /> waste as defined by 40 CFR Part 261 or♦ilia 22 of the Cailtomia code of regulations,has been properly <br /> described,classified and packaged,and is in proper condition for transportation according to applicable } <br /> regulations;AND,If the waste is a treatment residue of a previously restricted hazardous waste 1!1 <br /> and <br /> accordance with the reject to the Land quire entsal of Restrictions40 CFR Part 26a and isnolonger a hazardous waste as dat the waste has been treated efined by <br /> 40 OFA Part 261. RECEIVING FACILITY -- <br /> WASTE TYPE: 9 <br /> ❑DISPOSAL Q SLUDGE -- <br /> 0 CONSTRUCTION ❑WOOD <br /> C3 DEBRIS q OTHER — <br /> E]SPECIAL WASTE <br /> GENERATING FACILITY l <br /> :•'��EE�twt�ar ;fl'rR�i t��r� <br /> I <br /> TRANSPORTER <br /> NOTES: VEHICLE LICENSE NUMBER TRUCK k!L4 IBER <br /> ADDRESS <br /> CITY, STATE,-ZIP <br /> PHONE <br /> END DUMP BOTTOM DUMP TRANSFE=R <br /> rtQ�� <br /> ❑ �__ <br /> SIGN' TURF OF AUTHORIZED AGENT OR DRIVER DATE ROLL FF(S) FLAT-BED VAC\F DRUMS <br /> ❑ ❑ ❑ ] <br /> _ f <br /> CUBIC YARDS <br /> hereby certify that the above named material has been I <br /> 1 <br /> accepted and to the best of my knowledge the foregoing <br /> is true and accurate. DISPOSAL METHOD; {TQ BE COMPLETED$1 LANUFiI_I.) <br /> DISPOSE G HE <br /> REMARKS o SOIL <br /> 0 CONSTRUCTION <br /> FACILITY,TICKET NUMBER DEBRIS <br /> O NON-FRIABLE , <br /> , AUTHORIZED A Bt=BYOB <br /> SIGNATURE'OF <br /> e # f ¢ 'DATE O VI(OOD <br /> O ,SH <br /> Q,SPEC lk OTHER <br /> `5CHEDULIHa MUST DE MA16E PR)OR TO 3;00 P,M.THE DAYPRidA TO' XPECTIE�ARRIVAL•A119Y UIifStCF1E1�Ui.ED LOADS ARS$UBJECT <br /> TO 49lFUSAL UPON ARRIVAY.QI+IG®IRIG DAILY DELIVERIES MUST;BE SCHEDULED Yl4BTH TMS LANIpF11 X.THE DAY BEFOiiE <br /> �Nev 1 f <br /> 3 i 1/D9 NS 024 - - - GENT" ,rpt +- <br /> x R OR COPY MANIFEST# lig r 8 �, <br />