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L-IVx Ivio.0taln U IVe"y Isldnu K rvj WV&"U Sanitary Landfill Landfill . SaniEar Landfill unitary Landfill Landfill 901 Bailey Load 28972 Pittsburg, CA 94565 CButte Road 12310 San Mateo Road 1 Dixon Landing Road 5999 S. t;usiin Road Corvallis, OR 97330 Half Moon Bay, CA 94019 Milpitas, CA 95035 Manteca, CA 95336 � Phone(925) 458.9800 Phone (541) 745-2018 Phone (650) 726-1819 Phone(408) 945-2800 Phone (209) 937-4298 I Fax (925)458-9891 Fax (541) 745-3826 Fax (650) 726-9183 Fax (408) 262-2871 Fax(209) 982-1009 NON-HAZARDOUS WASTE MANIFEST . , GENERATOR spree to s, a WASTE ACCEPTANCE NO. MAILING ADDRESS 7MRC Smobifoliv err. -_ CITY, STATE, r'"' W +ZIP REQUIRED PERSONAL PIR TECTIVE E-Q _FPk/1EN_ PHONE [XGLOVES ❑ GOGGLES ❑ RESPIRATOR HARD FIAT ^f ❑TY-VEK ISSAFETY VEST CONTACT PERSON AMP-1 SPECIAL HANDLING�PROCEDURES: r SIGNATURE OF AUTHORIZED AGENT/TITLE DATE f x f l GENERATOR'S CERTIFICATION:I hereby certify that theabove namedhaterlal Is not a hazardous f waste as defined by 40 CFR Part 261 or title 22 of the Califamia code o1 te4ulatlons,has been prupedy described,classified and packaged,and Is in proper condition for transportation accardfng to applicable regulallons;AND,11 the weste.is a treatment residue of a previously restricted hazardous waste _ subject 10 the LaAd Oisp6sal Restrictions,I cert,fy and warrant that the waste has been treated In 'RECEIVING FACILITY accordance with the rectulretnenls of 40 CFFt.Pad,269 and is no longer a hazardous waste as def1pd by 40 CFR Pan WASTE tom : ,;00ISPOSAL " ❑SLUDGE Z1CONSTRUCTION ©WOOD i7 DEBRIS ❑OTHER , O SPECIAL`WASTE GENERATING FACILITY P ,21)50 t rct ah..-Ro y vrive TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUNIDER Daat l . ..-7 ,, , � - ADDRESS ,�- Pt c-twice Mw j57 CITY, STATE, ZIP [Avd1.'XA 93241 PHONE END DUMP BOTTOM DUMP TRANI4,1=ER SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS ❑ ❑ ❑ CUBIC YARDS I hereby certify that the abovenamed .material has been / Z - accepted and to the best Of my.knowledge the foregoing DISPOSAL MET OD: (TO BE COMPLETED BY LANDFILL) is true and accurate. DISPOSE GTI-! R O SOIL REMARKS ❑ CONSTRUCTION FACILITY T10KET NUMBER DEBRIS ' ___ ❑,No RIABLEJ f"T"ASBE TOS SIGNATU:E Off, UT'HO, IZED AGENT;' i DATE ❑ WOOD r r ❑ SPECIAL VTHER SCFiIEDiULIII MUST 8E MADEfP1410i1 O 3:00 P.II'I'Ti kE DAY PRIOR`Td EXPECTED ARRIVAL.ANY UNSCHEDULED LOADS ARE SEIBJECT TO REFUSAL UPON ARRIVAL.O 16III G DAILY DEL1vE41ES MUST IBE SCHEDUL9D WITH TFIE LANDFILL THE DAY BEFORE . . GENEATaRev 1109 Ns-m MANIFEST# l i