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..GtTVy r.7lgetu IJ F-JalVVCIU <br /> Sanitary Landfill Sanitary Landfill Sanitary landfill '`tet Landfill <br /> 901 Bailey Road0 San Mateo Road 1601 Dixon ing Road 9999 S.Austin Road <br /> Pittsburg,CA 94565 HMT Moon Bad+, CA 94019 . Milpitas, CA 35 Manteca,CA 95336 <br /> Phone(925)458-9800 °t' Phone(650) 726-1819 Phone(408)945-2800 Phone (209)982-4298 <br /> Fax(925)458-9891 Fax'(650)726-9183, Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> 1 <br /> GENERATOR .' '�. / ,- ' ,- WASTE.ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY, STATE, ZIP , i REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> f' Q GLOVES ❑GOGGLES 0 RESPIRATOR 1 EAT <br /> PHONE r� ----� �`, <br /> OTYVEK G]OTHER <br /> ' } <br /> CONTACT PER80N "" ~ <br /> • " SPECIAL HANDLING PROCEDURES: <br /> r � �C -11 <br /> SIGNATURE OF AUTF-ORIZED AGENT-./TITLE i' DATE, <br /> AN <br /> GENERATO`R'S CEfjTIFICAYiON:I hereby certify,that ihd`shovo named material is n9(a hazardous <br /> waste as.fleflned by40 CFR Pkrt 261'or title 22 of the Ckfomia code of regulations,has been proberly <br /> descl i4d,classiti and packaged/and is in proper cmiditiondor transportation a=cording to applicable ` r <br /> regulations,,ANO;I the waste is a treatment residue$of a previously restricted had ardour waste <br /> subject to the <br /> LandOispasal Restrictions,I certify and warrant that the waste has'been treated in RECEIVING FACILITY <br /> ` accordance with th ,requirements of 40 GFR Part 268 and is no longer a hazardous waste as defined by <br /> —AO CFR Part 264:...--.__.0 -- w__,,,,,,-.r ,....0 _ .._-......., .- :..,. a.. - - ..w <br /> WASTE TYPE: ..:•�''F I . <br /> a �P IJISPOSAL - - D SLUDGE= f .. <br /> �J CONStfCTIO V1fO0 <br /> C7 DEBRIS ❑OTHER 4...., ' <br /> U SPECIAL WASTE <br /> GENERATING FACILITY f <br /> TRANSPORTER NOTES:. VEHICLE LICENSE NUMBER. . TRUCK NUMBER," <br /> ADDRESS r .e. r ,rz,f ,f��� <br /> u. <br /> CITY, STATE,71P �.. . <br /> a. -''� <br /> PHONE f J -� '�. , , END DUMP BOTTOM DUMP TRANSFER ` <br /> Icr � f ❑ <br /> SIGNATURE OFAUTHORIZED AGENT OR DRIVER DATE j ROLL-OFF(S) FLAT-BED .VAN DRUMS <br /> IJ <br /> f` CUBIC YARDS <br /> _�. <br /> -1 hereby q rtify that thezbove named material has been , <br /> accepted End to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. s <br /> DISPOSE OTHER. <br /> U SOIL <br /> EMARKS'• <br /> ❑ CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FR IABLE I . <br /> —ASBESTOS .; <br /> SIGNATURE OFAUTHORIZED AGENT DQTE•-`-,, - ' ' ! <br /> r Q WOOD <br /> 1 F <br /> *1 f 'O SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED All 11 i4 NY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCf IT UTNE LANDFILL THE DA/;Y BEFORE. ' <br /> g j ,� MANIFEST# 4 4 `�4 .a 2 t,3 <br /> TRANSPORTER COPY �- � � <br />