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�- , >, ,...,tt,tt ouu.e LjOX Mountain ❑Newby Island ��• ,a Sanitar Landfill LarE.d�.,1 Sanitary Landfill Sanitary Landfill Landfill 901 Bailey Road.: . 28972�rn Butte Road 12310 San Mateo Road Pittsburg, CA 94565 Corvallis, OR 97330 601 Dixon Landing Road 9989 S.Austin road Phone(925)458-9800 Phone (541) 745-2018 Halt Moon Bay, CA 84079 Milpitas, CA 95035 _ Manteca, C�1�J5338 , Fax(925) 458-9891 Fax(541) 745 3826 Phone (650) 726-1819 Phone (408) 945-2800 Phone (209) 932-4298. Fax(650)726-9183 Fax(408) 262-2871 Fax (209) a2 1009 NON-HAZARDOUS WASTE MANIFEST � GENERATOR MAILING ADDRESS WASTE ACCEPTANCE NO. CITY, STATE, ZIP _ I REQUIRED PERSONAL PROTECTIVI= EC?U!F I,r1E{ "! . O I PHONE G?.GLOVES CI GOGGLES D RESPIRATOR N HARD HAT h 09)&14-76—f CONTACT PERSON ❑ TY-VEK [:SAFETY VEST Ante Oplex HANDLING PROCEDURES: SIGNATURE OF AUTHORIZED AGENT/TITLE DATE i GENERATOR'S CERTIFICATION:I hereby certify that the above named materia!is not a hazardous e 22 of describedwaste as, ssf ed a0nd packaged.a d fslin proper c ncililon fore California rtransporte of atioantaccording to applis bee p cable regulations;AND,It the waste is a treatment residue of a previously restricted hazardous waste p t subject to the Land Disposat Restrictions,I certify and warrant that the waste has been treated to accordance with the requirements of 40 CFR Part 268 and Is no longer a hazai'dous wasla es dLrrned by RECEIVING FACILITY ) 40 CFR Part 261, WASTE TYPE: ❑DISPOSAL ❑SLUDGE D CONSTRUCTION ❑WOOD ❑DEBRIS O OTHER D SPECIAL WASTE GENERATING FACILITY .20500 South ktally A'IvM TRA17Y TRANSPORTER Fd3i 11 L NOTES: VEHICLE LICENSE=NUMBER TRUCK NUT BER Oil --- ADDRESS .( ? CITY, STATE, ZIP PHONE END DUMP BOTTOM DUMP TRANSFER � SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATEPA ROLL-OFFS FLAT-BED VAN €SRU AS < CUBIC YARDS I hereby certify that the above named material has been accepted'and to the best of my knowledge the foregoing Is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) ' DISPOSE OI-IiCR 5•" �a REMARKS D SOIL O CONSTRUCTION i � FACILITY TICKETNUMBER DEBRIS ❑ NON-FRIABLE ASBESTOS F SIGNATURE OF AUTHORIZED AGENT DATE a`a ❑ WOOD ❑ ASH f ti SPECIAL OTHER z:�JiCI#E IDLING IWIdIST BE MADE PRIOR TO 3:06 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT � fO R. ... :UPON ARRIVAL.ONGOING DAILY DELlVIERIES MUST'BE:SCHEEDULEED WITH THE LANDFILL THE DAY 13EFOR.E Neb 11709 NS 024 , a F F wd �:" ..;-, . . , GENERATOR COPY.: MANIFEST# n .