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4 Ih Txi Ng 5 w 1 iw 4-A vt `' it'3i k .t �� [ _ p <br /> Nb n.� v }rt N F" f ! <br /> Oir Maun >lin A raiewbj► lsfand �xi. r orwardN�' <br /> Sq'I , ry,Landfill -Sanitary Landfill Sanitary Landfill Landfill <br /> ,vv 901,Balley Road` 12310 San Mateo Road '1601' 9999S Dixolt Landing Road Austen Road <br /> Pittsburg, CA 54565 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 { t <br /> IPHtONE <br /> ENERATO <br /> t WASTE ACCEPTANCE NO. <br /> G ADDRESS {TATE, ZIP r f t REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> a GLOVES ❑GOGGLES U RESPIRATOR U HARD HAT <br /> U TY-VEK O OTHER <br /> CONTACT PERSON <br /> 7—f rVqKJ f r _ ~` SPECIAL HANDLING PROCEDURES <br /> JSIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> S, nil <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 title 22 of the Celktorrua code of regulations has been properly <br /> described classified and packaged and is in proper oonditkon for transportation a-carding to applicable <br /> regulations AND,If the waste is a treatment reeldua of a prwrbusfy resUlictsd hazardous waste <br /> subject to the Land Disposal Restna4ons I certify and warrant thal 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 Part 261 <br /> NERWASTE TYPE <br /> SIXU DISPOSAL U SLUDGE <br /> ❑CONSTRUCTION U W OD <br /> U DEBRIS ER , <br /> MIL-15 SPECIAL WASTE <br /> GENERATING FACILITY <br /> yf. <br /> RANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS, 90S.2_ /s'J —T �7 <br /> CIE <br /> ATE, ZIP <br /> k <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> �k S� <br /> 0_0`( <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 METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate <br /> DISPOSE OTHER <br />' EMARKS O SOIL <br /> ❑CONSTRUCTION <br /> DEBRIFACILITYTICK' -NUMBS NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE F AUTHOR E AGENT DATE <br /> U WOOD <br /> U ASH <br /> ` U SPECIAL OTHER <br /> SCHEDULING MU 8E MADE`PRIORTO 3.04 P M THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHDIlLED LOADSARS SUt3.1EGT <br /> TO REFUSAL UP N ARRIV L. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> - -- MANIFEST* 43$7'0' <br />