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C11�e11erCanyanvonward <br /> q v, ;p-ll t i L y�y <br /> S' nitary Land ill �'�Sanllta(V Landflll� �!Sanitary,.Landflll �Lanc�fill}, ,w <br /> 901Bafley Road *w OR310®SantMated Road 1S01Ibix'oh LaMih Road -9999`S Austin Road <br /> P,Ittsburg,,CAA4565 r' Half�Modn.'Bay;CA 94019 M1�pitas;CA 85035 Manteca,CA 95336 <br /> Phone(925)458-9800 :{Phone(650);726-1819 <Phone(408)'945:2800 Phorfd(209)982=4298 , <br /> Fax(925) 458-9891 Fax(650)726-9183 Fax(408)262-2871 4Fax(209)982-100 <br /> NON-HAZARDOUS WASTE MANIFEST 9 <br /> GENERATOR C I WASTE ACCEPTANCE NO. <br /> r <br /> MAILING ADDRESS <br /> CITY STATE, ZIP L L tJ -2- REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ` ❑GLOVES ❑GOGGLES Q RESPIRATOR 0 HARD HAT <br /> PHONE ' <br /> O TY-VEK ❑OTHER <br /> CONTACT PERSON l - SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT 1 TITLE___j DATE ' <br /> GENERATORS CERTIFICATION 1 hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or Utte 22 of the Caldomna code of regulations has been property <br /> described classified and paokagsd and is in proper condition for transportation a^cording to applirabia <br /> regulations AND it the waste Is a treatment residua of a prwv%usy restricted hazardous waste <br /> aublect to the Land Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by ' <br /> 40 CFR Part 201. �. <br /> WASTE TYPE= <br /> ❑DISPOSAL U SLUDGE <br /> ❑CONSTRUCTION ',❑,�,WCOOD <br /> ❑DEBRIS �+Tmu <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORT`ETR 77 NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS 1 <br /> CITY, STATE,ZIP - t'" U - -- — <br /> PHONE 4 V_ END DUMP BOTTOM DUMP TRANSFER , <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE I ROLL-OFFS FLAT-BED VAN DRUMS <br /> 7kr% I r,- C - <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- DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) ' <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> ❑ SOIL ' <br /> .REMARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET N DEBRIS <br /> ❑NON-FRIABLE ' <br /> ASBESTOS <br /> SIGNATURE O AUTHORIZED T DA <br /> r ❑woon <br /> ❑ASH <br /> '� O CIAL OTHERAir <br /> 1 <br /> SCHEDULING MUST BE MADE PEIORTO 3.00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT' <br /> TO'FIEFUSAL UPON ARPIYAL.. ONGOING CtAILY„DELIVERIES'MUS ,SE,SCHEDULED WITH THE LANDFILL THE'DA}/Y,BEFORE. <br /> sj _ e,� a �• t tip,F:-'kea �, c s - V "+ <br /> Lw - � x, . ,. °; , , . _, �,��,„_ •' �M MANIFESf�k� _ f <br />