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-1i`K.T,�Stt'�.�SistK.�f^.'�^r�..�a.�n .��f�^e"-��.r ¢ �R^3^3' x � 'a+ �t r �,.. s�.x i r��, _ - .- <br /> J n e ler�nyon .V 1�� - [�r,( xJ Moun a�ln -;` °CI NQv�r� �y,;lslarlcl �o�wsar <br /> s ,a ttSfn '. ' ,l" F$ r �' '�-'E Y"iI", r',: "-€i" ` .�.-r'" r�;�.�u �' �-� _ fill <br /> S n�tar Lan�lf 1p ' E,' ,Sanitary,=L nc�fiil L Sanitary Landfill ' a <br /> °A1 E3aileRoad' ''£ gg t ` r' ;12310 San Mateo Road } 1601 piton Landing Road 9999S Austin Road <br /> Pittsburg,OA 94665 J Half Moon Bay, CA 94019 Milpitas,dA95035 Manteca, CA 95336 <br /> Phone (925)4 8-9800 X Phone(650)726-1819 Phone(408)945-2800 Phone (209)962-4298 <br /> Fax (925)458891 =r� Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> Y 'r <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR t WASTE ACCEPTANCE NO. <br /> 1v _{ <br /> MAILING ADDRESS t _ <br /> 4 t{ i ; <br /> CITY, STATE,ZIP - REQUIRED PERSONAE. PROTECTIVE EQUIPMENT <br /> f ❑GLOVES Q GOGGLES D RESPIRATOR ❑HARD HAT <br /> PHONE <br /> D TY VEK Q 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 matenal rs not a hazardous <br /> waste as defined by 40 CFR Part 261 or titie 22 of the Callfomla code of regulations has been property <br /> described classified and packaged and is in proper condtwn for transportation a-cording to applicable <br /> regulations AND If the waste Is a treatment residua of a previously restricted hazardous waste <br /> subiect to the Land Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements 01 40 CFR Part 269 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> U DISPOSAL U SLUDGE <br /> ©CONSTRUCTION U WOOD <br /> 13 DEBRIS A�LQTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> (-- A �7 <br /> RANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ( 6 t fo O'7`7 f-1 ►ZT'i A <br /> ADDRESS <br /> CITY, STATE, P <br /> PHONE I END DUMP BOTTOM DUMP TRANSFER <br /> a <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> * -ick_©` <br /> i <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 METHOb (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate <br /> DISPOSE OTHER <br /> O SOIL <br />' REMARKS <br /> 4 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIA9LE <br />' A ASBESTOS <br /> SIG NAT R OFZED GENT DATE <br /> _ ❑WOOD <br /> U ASH <br /> *; - ❑SPECIAL OTHER - ' <br /> I <br /> SCHEDULING MUST BE MADE PRIORTO • RM THE DAY PRtOR70 EX <br /> TO REFUSAL UPON ARPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> ONGOING DAILY DELIVERIES MUST-BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> '` ` ��"`� �I1 0, " ' , MANIFEST # --�j Z <br />