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-. �ealgnyon���,� a. ,v � a� � r` x. ,'Y uy rye�►pylls�ana r h ,x-, ' <br /> i <br /> gyp , �} rorrz # �x Nr ti RF, �< <br /> Sanita�y a til ill' t S inita�Lar d#illi , S�nita , Land#ill, =`r R an-df 11, <br /> �x 9(YI�B fley'R�pad, ;' �r , 12310 Sffttn.M3tea R ads X160,6 1'onat`ndIng Road 9999 SAi�sti- Road <br /> byn V k ♦ t tt iF w }k ,3 h � tY 9 N+ <br /> Pi tsburg,'CA 94585,,' " Half h oon Bay, CA°94019 MjVia6;CA 95035-t - Manteca,CA 95336 <br /> Phone(925)458-9800 X4 Phone(650)726'1819 ` Phone""(408)945=2800 Phpne(209)982=429 <br /> Fax(925)458-9891 ,Zax'(650)726-9183 Fax(408}`262-2671 Fax(209)982-1009 1 <br /> NON-HAZARDOUS WASTE MANIFEST . <br /> GENERATOR WASTE ACCEPTANCE PO. { <br /> MAILING ADDRESS <br /> , r <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE 0 GLOVES ❑GOGGLES LI RESPIRATOR 0 HARD HAT <br /> ❑TY-VEK Il OTHER <br /> CONTACT PERSONj AQ <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE / r <br /> 1f/( <br /> GENERATOR S CERTIFICATION I hereby certify,that the above named material is not a hazardous <br /> waste as defined by 40 GFR Part 261 or We 22 of the Cafifoma code of regulations has been property <br /> described classified and packaged and is in proper condition tot transportation axordtng to applicable <br /> regulations AND,If the waste is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions I comfy and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 265 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> O DISPOSAL U SLUDGE <br /> ❑CONSTRUCTION 0 WOOD <br /> 0 DEBRIS <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER ., NOTES VEHICLE LICENSE NUMBER TRUCK NUMBS <br /> _7 vIle , 7 711 C__ -7 <br /> ADDRESS <br /> CITY, STATE,ZIP <br /> PHONE._ - _____ =END DUMP_ BOTTOM DUMP- ; =TRANSFER= <br /> ❑ ❑ 14 <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER - DATE- - - TROLL-OFF S <br />