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'a t r^`•-YSrRte r�.5-- 3rR 3+tx e.a "`ET <br /> _ _ <br /> is { + ' xj —�i 9 7N =3� l dFs��fs a aT " * is j ii s ty»r <br /> �� @�y1�.�Ca11y411c rr�` ' �r�'.0) OLI�'1 a �3 .� ,ET N�� x� �anC�Er ,Mr �� 1 WArLi Y x r <br /> Jy.ui * yew'# j�S'3 6rini 43 lyl� C L ,y.�4{ Sr'y3' Rr'.L ,( ..k .? <br /> 1' ,ax sp FK4-„ <br /> •� anitary.Landfill :rSanitary"LIflllm Sanitary Landfills °Landfill <br /> e r o rrJ r� r#7 ssv ,�os� ^w atr�i,"fi'.� <br /> µ` 901,Halley Road; F, . :j ),,-1231 Q San MaWkfA8ad _ 1X01 f)xor�il ar ding Poad r w. 9999 S`Austen Road <br /> Pittsburg,CA 94565 Half Moon Bay, G4 94019_ - Ilpltas,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) 982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR _ - -- l WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS ...W <br /> �L4 <br /> CITY, STATE, Zip REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE <br /> Q GLOVES ❑GOGGLES U RESPIRATOR ❑HARD HAT <br /> ❑TY VEK O OTHER <br /> CONTACT PERSON f SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE W <br /> GENERATOR S CERTIFICATION I hereby caditfy that the above named material is not hazardous 4 - <br /> waste as defined by 40 CFR Part 261 or title 22 of the Cafrfomia code of regulations has been properly <br /> described classified and packaged and to to proper condition for transportation a-cording to appito i <br /> regulations AND If the waste Is a treatmaint residue of a previously restricted hazardous waste <br /> &.0th <br /> subject to a Land Disposal ResUvAons I certify and warrant ea the waste has bean treated in RECEIVING FACILITY <br /> accordance with the ragwrements of 40 CFR Part 268 and is N longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> 0 DISPOSAL a SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ;.'QTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY t <br /> v ♦,j { ` '� r X � T <br /> TRANSPORTER 'k NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY,-STATE;ZIP= <br /> PHONE- =END DUMP-` BOTTOM DUMP =TRANSFER= <br /> — - SIGNATURE OF AUTHORIZED AGENT OR DRIVER- DATE--_� ==ROLL-OFF(S)—-—FLAT-BED -VAN----DRUMS-- - <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 trate and accurate <br /> , <br /> DISPOSE OTHER <br /> D ' <br /> REMARKS SOIL <br /> ID CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> 0 NON-FRIABLE ' <br /> SIGNATUIJE,OF AUTH AGENT DATE ASBESTOS <br /> ❑WOOD <br /> 0 ASH <br /> 0 SPECIALOTHI=R <br /> i_ ,. +w,NwKs+r�wrF, ,n, <br /> SCHEDULING MUST BE E IORTO 3:00 RM THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT' <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE rLANDFILL THE DAY/�BEFOR7E• <br /> ` MANIFEST# t ri A <br /> a },r <br /> ` _ f�Cmt=ner• oe-ntlV <br />