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,f,�-.}' � q{a'" r,r;�+ E r�. 3. i`+ .� e 1'� <br /> €��['i� SSp���yy pp � �.e !�j�� r �,y��L `°. '".h CY'k}E���".'+� �y a4hV i�1jhE ��r ri"'n°r y . �„ l" r �[k" ?,.'� Ike ler, l�any+on Fr „ ,❑ Ox,Mounin , ,T - ' N wh lsian f.�twonwardxy4� d''F� '_rSanftarjr'Landfll " 1Sariltary ndfill Sanitary`Landfill ,` Landfill s <br /> 90 f Bailey Road ,, 12310 San Mateo Road 1'601 Dlzon l anding Road 9999$ 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) 982-1 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR / WASTE ACCEPTANCE NO. <br /> F f 4 <br /> MAILING ADDRESS , _ � Y <br /> CITY, STATE,ZIP �. � r <br /> REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE <br /> ❑GLOVES 0 GOGGLES 0 RESPIRATOR 0 HARD HAT <br /> ❑TY-VEK 0 OTHER <br /> CONTACT PERSON „ <br /> - SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material Is not a hazardous <br /> :.2110 as defined by 40 CFR Part 261 or title 22 of the California code of regulations has been property <br /> described alaasrited and packaged and Is In proper condition for transportation&-carding to applicable <br /> regulations AHM H ttm waste Is a treatment residue pf a prwlously restricted hazardous waste <br /> subject to the Land Disposal Restrictions I certify and warrant that the waste has been treated In <br /> accordance with the requirements of 40 CFR Pan 266 and Is no longer a hazardous waste as defined by RECEIVING FACILITY <br /> 40 CFR Pail 261 _ <br /> WASTE TYPE <br /> 0 DISPOSAL 0 SLUDGE <br /> ©CONSTRUCTION p OOD <br /> U DEBRIS HEFT <br /> 0 SPECIAL WASTE a <br /> GENERATING FACILITY <br /> zsfr <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS f 5Z_ Q � <br /> CITY, STATE,ZIP y T i�� <br /> PHONE - END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE - ROLL-OFFS FLAT-BED VAN DRUMS <br /> * eZ -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 <br /> Is true and accurate. DISPOSAL METHOD (TO 8E COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS 0 SOIL <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> D NON-FRIABLE <br /> ASBESTOS <br /> SIGN A RE OF-A�LIEHOR10b AGENT DATE <br /> ❑WOOD <br /> 0 ASH <br /> C OTHER <br /> SCHEDULING MUST SE MADE PRIORT0 3:00 RM THE DAY PRIORTO EXPECTED VAL•ANY UNSCHEDULED LOADS ARE SUBJE <br /> CTO <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST,BE SCHEDULED WITH THE LANDFILL THEDAY BEFORE. <br /> - - -- - $ ►4egticeer eft"'z!1' .���`� <br />