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"3"1V '�Ke lr a' 1�fit- e h,� _ S r s <br /> flZoz�oUnt�In, � - _ � d � 4N iivbY I � �� _ �, t�77-aa��� <br /> z T ,i.y e�" 7 i' mew+ut �� T sland� ��fia <br /> •}�`Sani#aryr�andfill r -a'Sigltary Landfill '0. Sanitary',Lan`dfill Landfill <br /> 901'13allet'Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay, CA`94019 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) 982-10 <br /> N�N-HAZARDOUS WASTE MANIFEST <br /> - GENERATO jf <br /> h t t WASTE ACCEPTANCE NO. <br /> MAILING ADDRES <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> k _ <br /> PHONE - 0 GLOVES Q GOGGLES Q RESPIRATOR Q HARD HAT <br /> CONTACT PERSO X <br /> O TY-VEK ❑OTHER <br /> SPECIAL HANDLING PROCEDURES - <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE �, r <br /> GENERATOR 5 CER-nRCATION I hereby eerldy that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California coda of regulations has been properly <br /> described classrfied and packaged and Is in proper condition for transportation a^cordrng to applicable <br /> regulations ANG,n tht warts Ise treatment residue of a previaasly nestrteted hazardous waste <br /> subject tothe with d Disposal Restrictions I"r* <br /> and warrant that the waste has been treated inIrdRECEIVING FACILITY <br /> 40 CFR Part 261 he requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined <br /> WASTE TYPE f <br /> ❑DISPOSAL ❑SLUDGE <br /> Q CONSTRUCTION Cl WOOD <br /> O PECI <br /> SA IER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY;STATES ZIP - —v — <br /> HONE END DUMP BOTTOM DUMP TRANS R <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS 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 foregoin <br /> Is true and accurate. g DISPOSAL METHOD -(TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> EMARKS Q SOIL <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> ASBESTOS <br /> SIGNATU E OF�It1TFIORIZ T DATE <br /> Q WOOD <br /> f S _ <br /> i <br /> Q S AL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3 00 P M THE DA PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED L0jbS ARE SUBJEC� <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> MANIFEST# -,A3678 <br />