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"yeu ii> L 5�t°E"'! dN�x 3'{ .a- w Y ♦F r iy"drxa.a�.hr<a'.,"Sr 'ft�T�s-x. . 'sYRYM� <br /> --.J7�J,Sana. <br /> �7 l' I �hdd <br /> f r 4 s �andtea afi uY <br /> Sanaaancf� eFSa � fill <br /> r, . Lit , <br /> ry, � 11 } on Landing Road 9999S A <br /> ustin Road ad9U1 8ais d = n <br /> t <br /> kfiburb,'CA 94565 u Half Maori Bay;'C*194019 ,_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 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> � <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> f <br /> MAILING ADDRESS , <br /> 4_ 4f"I <br /> STATE, ZIP f <br /> CITY _ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE <br /> GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> O TY-VEK ❑OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> —S <br /> GENERATOR S CERTIFICATION I hereby certity that the above named material is not a hazardous µ <br /> waste as defined by 40 CFR Part 261 or title 22 of the Calrtamia code of regulations has been property <br /> described,classified and packaged and rs in proper oondltron for transportation axording to applicable <br /> regulations AND If the waste Is a treatmerit residue of a previously restricted hazardous waste <br /> subject to the Lard Disposal Restric0ons I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Pair 268 and is no longer a hazardous waste as defined by <br /> 40 CFA Part 261 <br /> WASTE TYPE <br /> ❑DISPOSAL 0 SLUDGE <br /> ❑CONSTRUCTION ❑VyOOD <br /> ❑DEBRIS THEA I <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY / <br /> TRANSPORTER _ NOTES VEHICLE LICENSE NUMBER TRUCK NUMBS <br /> ADDRESS t '- <br /> CITY,=STATE;ZI - - - - -- - <br /> --- <br /> PHONE=Q= _ - = _ - - --- —END DUMP --BOTTOM DUMP -TRANSFER <br /> - SIGNATURE OF AUTHORIZED AGENT OR DRIVER— " DATE- -T "'ROLL=OFFS FLAT-BED VAN DR UMS <br /> 1 ❑ ❑ ❑ ❑ <br /> * <br /> CUBIC YARDS <br /> 1 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 /> REMARKS ❑SOIL <br /> .. I <br /> ❑CONSTRUCTION <br /> FACILITY TICKS NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE-O ORIZ VAGENT DAT!_ <br /> ❑WOOD <br /> ❑ASH <br /> ❑ SPECIAL Oi HER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P M.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 /> " MANIFEST 0 - 43495 <br />