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LJ �w,rrci.wa�'jyVr!I. L_j VA IWJVUIILC2111 LJ IiCWWY IJIQIIu J rurwaru <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey 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)982-4298 <br /> Fax(925)458-9891 Fax(650) 726-9183 Fax(408)262-2871 Fax (209) 982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> •t <br /> MAILING ADDRESS <br /> A.77 13nak — <br /> ;` &I-Iii, ("orle 11)4 A sav: <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> S. n F cc ' C`.A 0.41')0 Q GLOVES U GOGGLES U RESPIRATOR O HARD HAT <br /> PHONE <br /> - :-- - U TY VEK U OTHER <br /> CONT c R O RabSPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> Atd',an-iz d AAcnt for <br /> � • l', / Ftu:'sfi•C bL F.icctr-ir: `�/' <br /> GENERATOR'S CERTIFICATION:I hereby carlify that the above named material is not a hazardous 1`1Utlk• <br /> waste as defined by 40 CFR Part 261 or We 22 of the California code of regulations,has been property <br /> described,classified and packaged,and is in proper condition for transportation a'cording to applicable <br /> regulations;AND,It the waste is a treatment residue of a previously restricted hszardous waste <br /> subjeta to the Lard 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 Part 261. <br /> WASTE TYPE: <br /> DISPOSAL U SLUDGE <br /> O CONSTRUCTION U WOOD <br /> 0 DEBRIS ❑OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> zhuritimi JDchydraliur Thurniuli <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> L)CnBeste Transportation <br /> ADDRESS <br /> _.0 D cn gcite f".t. <br /> CITY,STATE,ZIP <br /> -- CA `d9 2 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF UTHORIZEDAGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <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 /> FtEMARKS U SOIL <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> 0 NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> 0 WOOD <br /> 0 ASH <br /> 0 SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORT0 3:00 P.M.THE DAY PRIORTO EXPPECTED ARRIVAL a ANY UNSCHEDULEb LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> RAAAt1CCw <br /> Q / <br /> CT,% Q A 1 Q <br />