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Sanitary Landfill Landfill `.-'f%,A ivlouncain LJ ivewuy istartuXJ rs rva;s l <br /> 901 BaileyRaad Sanitar r andfill "-.Sanitary Landfill <br /> 28972 in Butte Road 1'2310 San Ma Mateo Road U601 Dixon Landing Road 9999 SLadd�ki3tin tivad ., <br /> Pittsburg, CA 945fi5 Corvailt <br /> llis, OR 97330 <br /> Phone (925) 458=9800Half Moon Bay, CA 94019 Milpitas, CA 95035 <br /> Phone (541) 745.2018 Phone(650) 726-1819 Phone 408 945.2840 Manteca' 0) 35 38 <br /> Fax(925)458-9891 Fax(541) 745-3826 ( ) Phone [20 } °E�2-42 8 <br /> Fax(650)726-9183 Fax(408) 262-2871 Fax (1 09) 98?_-.1009 <br /> GENERATOR <br /> NONHAZARDOUS WASTE MANIFEST <br /> � <br /> WASTE ACCEPTANCE N®e _ <br /> MAILING ADDRESS <br /> 2055 South 11s511!,' <br /> CITY, STATE, ZIP REOUIRED PERSONAL PROTECTIVE EC71�Fiti%; _j,! <br /> PHONE ff-GLOVES .0 GOGGLES © RESPIRATOR f JU HARD HAT <br /> CONTACT PERSON <br /> 0 TY VEK ID SAFETY VEST , <br /> SPECIAL HANDLING PROCEDURES: T�� <br /> SIGNATURI= OF AUTHORIZED AGENT/TITLE. DATE <br /> 7 <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazattlous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been ompedy <br /> described,c€assified and packaged,and is rn proper condition for transportation according to applicable <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 longer a hazardous waste as d?lined by RECEIVING FACILITY <br /> 40 CFR Pad 261. <br /> WASTE TYPE: <br /> 'P,JISPOSAL Q SLUDGE — <br /> Q CONSTRUCTION 0 WOOD `- <br /> CI DEBRiS 0 OTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITYmom <br /> i <br /> TRANSPORTER <br /> NOTES: VEHICLE LICENSE NUMBER TRUCK NL1149ER <br /> AM Thow",Oil fttc: ----- <br /> ADDRESS <br /> E" ILI <br /> — <br /> CITY, STATE, ZIP r <br /> LPdk,CA 95241E <br /> PHONE `` END DUMPJ201 122--548 BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN _ L�I1'J1RS <br /> CUBIC YARDS <br /> I 1 hereby certify that the above named material has been . . <br /> accepted and to the beat of my knowledge the foregoing _ <br /> is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHEF3 <br /> REMARKS ❑ SOIL -- <br /> a CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> SIGNATURE!OF.AUTHORIZED.AGENT ASBE. TOS <br /> �•' <br /> ell ASH <br /> E <br /> SPE(, OTHER <br /> SCHEE! tiall�G MUST BE MAfD RIOR TO 3:00 P.M.`rNE DAY PRIOR.T6 iIP@CTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> 'PO REFUSAL <br /> UPONARIOVAL.QNGAIMG DAISY t>fE1.1VERIES SCFI <br /> 11iiUST;BE EI}ULEU WITH THE LANDFILL THE: DAY BEFORE. <br /> `i Rev t1�os Ns 024 GENERATOR COPY MANIFEST# <br />