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Sanitary Landfill Landfill <br /> u..•• tyiVy���ni rutvtr�+ttii., max+ <br /> 901 BaIle Road Sanitar. Landfill Sanitar LandfillLandfill y 28972 n Butte Road 12310 San Mateo Road 5 01 Dixo.Landing Road 9999 5��.lstin Road <br /> Pittsburg CA 94565 Corvallis R 97330 1 <br /> Phone (925)458.9800 Phone(541J 745 2018 Half Moori gay,CA 94019 Milpitas, CA 95035 <br /> Manteca, Ce, 95336 <br /> Fax (925)458-9891 Fax (541) 745-3826 Phone (650)726.1819 Phone (408) 945-2800 Phone (2r)g) _Ba-4298 <br /> Fax (650) 726-9183 Fax (408)262-2871 ax (209) 992-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE <br /> �pg @ ACCEPTANCE <br /> �i gr J��y/q�+ q� <br /> 6+ writ': 1P. IfC,F+q�7TE A1�41EPG M>sil'Y!6 �6®e -4 j <br /> MAILING ADDRESS <br /> -0,500 seuth:f .,_Ah7 Drive f <br /> CITY, STATE, ZIP 9.914 <br /> CA3is-4 REQUIRED PERSONAL PROTECTIVE EOl)! 'e1 Eh,IT <br /> PHONE J�GLOVES .O GOGGLES ❑ RESPIRATOR XI HARD HAT <br /> Csr D TY-VEK fYSAFETY VEST <br /> CONTACT PERSON <br /> �nr 0amy SPECIAL HANDLING PROCEDURES: �— <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:i hereby certify that the above named material Is not a hazal0ous' <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code or 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' <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 2613 and is no longer a hazardous waste as dgTned by RECEIVING FACILITY — <br /> 40 GFR Part 261. di <br /> fined <br /> TYPE: <br /> .,U4 'iSPOSAL ❑SLUDGE - -- <br /> O CONSTRUCTION. -- <br /> ❑DEBRIS Q OTHER <br /> ❑SPECIAL WASTE, <br /> GENERATING FACILITY _ II <br /> TRANSPORTER s��� ti , �2- <br /> ffgi3. <br /> NOTES. VEHICLE LICENSE NUMBER TRUCK, NUMBER <br /> lye <br /> ADDRESS:: <br /> CITY, STATE, ZIP` <br /> l <br /> PHONE END DUMB BOTTOM DUMP _ TFIAII�SFER I <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATELJ <br /> ROLL OFFS FLAT-BED VAN DFi!JsliS <br /> © G U I1 <br /> CUBIC YARDS <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 O'T HrT, <br /> REMARKS ❑ SOIL <br /> f f i ❑ CONSTRUCTION <br /> FACII_ITY,.'TICKET NUMBER DEBRIS <br /> f. } <br /> Q.NON-FRIABLE ---__ <br /> ASBESTOS <br /> SIGNATURf= OF tJTHQRIZED AGENT DATE <br /> WO D <br /> Ll A3A <br /> ��,` '� � f ✓` •�', e,��" ❑ PECIAL OTHER <br /> �• <br /> SCHEDULING MUST DS NtibiE4RI6R T0-3.00 P M.THE DAY PRIOR YO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS AIME SUBJECT <br /> TO REFUSAL UPON ARRIVAL.Oid_®OINK DAILY DELIVERIES MUST BESCII�#E®BLED WITH THE LANDFILL THE DAY BEFORE. <br /> Rev 11109 N,9-624 GENERATOR COPY MANIFEST# +�, R�• <br />