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tEm ,yam+ 4r'h' ti 1-1 ria sa h" �� a ac <br /> ' k Y 0 n ii �r�'�� V r IS �`�'�'' �� J v-3 � <br /> � � f 4. Y -Y+ 1`.J�la{[� �, L' � f �� �r7 k,:' i rA` <br /> " reale Y anyc�ir ..�t� MOW <br /> Olranta nh, r p Newtiy Island` ., Forwar�tf <br /> Y�+If rRYU0�. s l] M¢�'+f � <br /> k QSaln1tary Landfill" s Sanitary,Landfill Sanitary Landfjtl Landfill <br /> 4;9UBal1f3}ij3oad "',12310 San�Mateo`Road 1601`Dixon Landing Road 9999 S Austin Road <br /> Pittsburg, CA 94565' 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)982-429 <br /> Fax(925) 458-9891 Fax 1650)726-9183 Fax(408)262-2871 Fax(209)982-10� <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR%,. WASTE ACCEPTANCE NO. <br /> I 01 10C_ oek <br /> MAILING ADDRESS r I yv1 _ �►� <br /> or o <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE <br /> Q GLOVES ❑GOGGLES Q RESPIRATOR O HARD HAT <br /> An Q TY-VEK ❑OTHER <br /> CONTACT PERSON 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 /> waste as defined by 40 CFR Part 261 or title 22 of the Caldomia code of regulations has been properly <br /> described classified and packaged and is in proper condition for transportation a-carding to applicable <br /> regulations AND,If the west&in a treatment residue of a previously restricted hazardous waste <br /> Subject Land Disposal flestnctions I cemty and warrant that the waste has bean treated m RECEIVING FACILITY <br /> with the requiremants of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> Q DISPOSAL ❑SLUDGE <br /> Q CONSTRUCTION ❑WOOD <br /> O DEBRIS XOTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> V4 n L.re'n f—v n <br /> TRANSPORTER f NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS �� <br /> CITY, STATE, ZIP - — <br /> PHONE -- - -- _ END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL--OFF(S) FLAT-BED VAN DRUMS <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- <br /> is true and accurate 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 /> ISIGNATUREOF,AU ORIZ GENT DATE <br /> a WOOD <br /> 1 _ O ASH <br /> r <br /> Q SPECIAL OTHER <br /> SCHEDULING MUST BEM DE PRI RTO 3:00 PXTHE DAY PRIORTO EXPECTED ARRIVAL,a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON AR Ir"ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BIEFORE. <br /> GENERATOR,COPY MANIFEST# <br /> «_ <br />