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��z a��'TMr��t � ��' '..f <br /> � ,,�s�lC onward =� <br /> ry�,�t�araj,r i_?t,,., era, 'a+✓"'�=k TX�.g;r �Lan`tlfili <br /> sa�litarytL:antlfll! k _ Sanfta� rLandfill Sanitary Landfill <br /> � �m w � ,, <br /> ,901 Bai(ey`R`oad 1�s s 12310 San, i teo Roada 1601 Duron Landing Road 9999 S Austin Road <br /> Pittsburg,CA94565 Half Moon Say;CA`94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone (925)458-9800 Phone(650) 726-1819 Phone(408)945-2800 Phone (209)982-4298 <br /> Fax(925) 458-9891 Fax (650) 726-9183 Fax(408) 262-2871 Fax (209)982-1009 <br /> .. NON-HAZARDOUS WASTE MANIFEST <br /> GENERATO t _ WASTE ACCEPTANCE NO. <br /> T <br /> MAILING ADDRESS1,;2 <br /> r k r <br /> CITY, STATE, ZIP - y, REQUIRED PERSONAL. PROTECTIVE EQUIPMENT <br /> con ' ❑GLOVES ❑GOGGLES ❑RESPIRATOR U HARD HAT <br /> PHONE <br /> ❑TY-VEK 0 OTHER <br /> CONTACT PERSON <br /> , f .... SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> So <br /> GENERATOR S CERTIFICATION i hereby certify that the above named material Is not a hazardous <br /> waste as defined by 40 CFR Part 261 or rifle 22 of Me Caldomia code of regulations has been properly <br /> described classified and packaged and is in proper condition for transportation a-cording to applicable <br /> regulations AND,if the watts Is s treatment residue of a previously restricted hazardous waste <br /> subject to Me 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 Pan 261 <br /> rQ <br /> TE TYPE <br /> DISPOSAL ❑SLUDGE <br /> CONSTRUCTION ❑ OD <br /> DEBRIS <br /> SPECIAL WASTE <br /> GENERATINNG/fFA�CfIILITY <br /> 4R�A�NSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> d i - <br /> VM27 <br /> ADDRESS <br /> CITY,STATE, ZIP J <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN TkRUMS <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> 1 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 /> EMARKS ❑SOIL <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OFAUTHORCED ArRENT DATE <br /> ❑WOOD <br /> ❑ASH <br /> © SPECIAL OTHER <br /> SCHEDULING MUST BE MA(E PRIOR 3:00 PM THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARR VAL ON OING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> MANIFEST# - 43679 <br />