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t S tt^"CN �16+ <br /> �fi.+.� �3 v se <br /> rs:•`�"' , -.c,i '-t sv d ''a' • a^ -u r r+ <br /> b y ya ti (�, ounta>in;rF r''`_ - NeW Island'-l-"", <br /> Is K i' n 0.rYY 'S."�iYrX7 i^ i 1 'i't'Stj N' N-wLj�k'4 A x'11 .Mr° <br /> al ltally�Landf(II Sanitaly L-anTdflllr -,, ;`Sanitary La6dfill Landflll,l <br /> . 9 ""' F`,R Vat'., �'� �> a �.�u. �,w <br /> � 12310 San`Mateo Road - " 1601 Dlzon Landing Road 9999 S Austro Road <br /> Plttsb ` ;CA 94565 Haff Moon'Bay,CA 94019 Milpitas,CA 95035 Manteca, CA 95336 <br /> Phone (925)458-9800 Phone(650) 726-1819 Phone(408)945-2800 Phone(209)982-429✓ <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209) 982-100 <br /> NON-HAZARDOUS WASTE MANIFEST W - <br /> v ; 4 <br /> GENERATORC WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> 3 - (4 CrJ <br /> CITY STATE, ZfP L REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE U GLOVES 0 GOGGLES D RESPIRATOR U HARD HAT <br /> ❑TY-VEK 0 OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material is not:hazardous <br /> waste as defined by 40 CFR Pari 261 or Utle 22 of the California code of regulations has been property <br /> de= des 12Z and packaged and is In proper condtfion for transportation iii-cording to applicable <br /> regulations AND,it the waste to a treatment residua of•previously rsstrlctsd hazardous waste <br /> subject to the Land Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> aCCardance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as petined by <br /> 40 CFR Part 261 <br /> WASTE TYPE ` <br /> U DISPOSAL U SLUDGE <br /> U CONSTRUCTION U WOOD <br /> O DEBRIS 'OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> = <br /> LA cJ,L\ T!�,v)Pe <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS �-TA D ' <br /> CITY;STATE;ZtP= _ - - — _ - - - — - — <br /> =END DUMP _-—BOTTOM DUMP--—--TRANSFER ' <br /> ❑ ❑ <br /> — SIGNATURE OF AUTHORIZED AGENT OR DRIVER_r - DATE— --ROLL--OFF(S)—- FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ , <br /> CUBIC YARDS ' <br /> I hereby certify that the above named material has been ` <br /> 7 <br /> accepted and to the best of my knowledge the f agoing DISPOSAL METHOD - ' <br /> Is true and accurate (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS U SOIL , <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER—t I A I I DEBRIS <br /> U NON-FRIABLE ' <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZiT ENT DATE <br /> ❑WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORT0 3 00 RM THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL, ONGOING DAILY,DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> +� p <br /> MANIFEST* �7f7 <br />