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++gary i_anatin Landfill - <br /> 901 Bailey Road 28972 Sanitary Landfill Sanitary Landfill r. Landfill <br /> Pittsburg CA 94565 n Butte Road 12310 San Mateo Road `p01 Dixon Landing Road 9999 S. Austin Hoad <br /> Phone(925)458-9800 Ph nelR 97330 Half Moon Bay, CA 94019 Iipitas, CA 95035 <br /> ( 1) 745-2018 Fax(650)726-9183`Phone(650) 726-1819 Phone 408) 945-2800 Manteca, 9) 5 336 <br /> Fax(925) 458-9691 ; <br /> Fax(541) 745-3826 Fax(408)262-2871 Phone (20 982-4298 <br /> Fax (209) 982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY, STATE; ZIP 91.1 _ <br /> r tc t� A a ih� REQUIRED PERSONAf� PROTECTIVE EQUIPP i}=_IdT <br /> PHONE (GLOVES ❑ GOGGLES ❑ RESPIRATOR HARD HAT <br /> 01 <br /> RS <br /> CONTTACTACT PERSON O TY-VEK ff-SAFETY VEST ) <br /> Arm e 0 SPECIAL HANDLING PROCEDURES: —T <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE. DATE <br /> GENERATOR'S CERTIFICATION:)hereby aertlfy that the above named material Is not a hazaroaus <br /> wasta as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properfy <br /> described,classified and packaged,and is in proper condition for transportation according to spollcable <br /> regulations;AND,If the waste Is a treatment residue of a Previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated In _ <br /> accordance with the requirements of 40 CFR part 268 and Is no!anger a hazardous waste as defined by RECEIVING FACILITY ` <br /> 40 CFR Part 261,. <br /> WASTE TYPE: <br /> ❑DISPOSAL' ❑SLUDGE <br /> Q CONSTRUCTION a WOOD <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> ' E <br /> TRANSPORTER <br /> NOTES: VEHICLE LICENSE NUMBER TP CIS NUTARER <br /> ADDRESS l� /.; <br /> CITY, STATE, ZIP <br /> 41di-CA 95241. <br /> PHONE -- <br /> END DUMP BOTTOM DUMP TF�fJFER <br /> ❑ ❑ I� <br /> S GN TUBE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DFIUMS <br /> ❑ ❑ ❑ �❑ <br /> . . 1�C i`:^ ; ,t rpt_ �;�-., l. �• . .t � ' <br /> ME <br /> CUBIC YARD ` <br /> S <br /> '`. I hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing <br /> is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OT. IER <br /> REMARKS v ❑ SOIL — <br /> ❑ CONSTRUCTION <br /> F <br /> DEBRIS <br /> Ai <br /> C LITY T[CKET N <br /> UMBER <br /> ❑ NON-FRIA LE <br /> SIGNATURE OF AUTHORIZE AGENT DATE A BESTQS <br /> jl 1, !r h R 1+1�OOD F <br /> v f' �, � r f ❑ jASH <br /> k i <br /> LI'SPECIAL OTHER <br /> To <br /> SCREDULING MUST BE MAPi PRIOR TO 3:00 P.M.THi DAY,PRIOR TO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> ) <br /> REFUSAL UPON ARRIiIAL. ONGOING DAILY DELIYlERIIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> 11/09 NS 024 GENERATOR.COPY MANIFEST# fd ~c,',' - . <br /> �_.._,..'.,. --. .: -1 ., __-._.. ..r_........-._„_x—.-..—.w—.W ..J,n�::.::�_._--.=_�Y:`.iL:.C-•.............:..-:..::�. ._:-x5. s-...w..:.�si—. ....._ ... _a,.. ._ f <br />