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�J Feller Vanyon L_j VA,IVILIF UI IUra111Iu si.r�xr !y p'WF%*sj <br /> T:anitary Landfill Sanitary Landfill Ssr# civ§)LA6661t, Landfill, <br /> S < Bailey Road 12310 San Mateo Road 1601 Dixoh Larding Road 9999 S Austin Road <br /> Pittsburg, CA 94565 r - Half Moon Bay, CA 94019 blilpltks,-GA'9005 , Manteca,CA 95336 <br /> Phone (925)458-9800 Phone(650)726-1819 F?Itone,(00),9,45- 800 Phone (209)982-4298 <br /> Fax(924 458-9891 Fax(650)7269183 Fax(400)262 1 401 ' Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MAN11FISSi'7' <br /> GENERATOR ,WASTE ACCEPTANCE NO. <br /> Man, Sanche7 <br /> MAILING A DRESS _ <br /> y <br /> 33 W-walnut Street <br /> CITY, STATE, ZIP REQUIRED PERSONAL P TECTIVE EQUIP-MENT <br /> ❑GLOVES ❑GOGGLES to RESPIRATOR ❑HARD HAT <br /> PHONE <br /> U TY V�K , O OTHER <br /> CONTA PER N SPECIAL HANDLING PROCEDURES <br /> vivo -rh"Ai <br /> SIGNATURE OF AUT ORIZED AGENT/TITLE DATE <br /> 3-0 <br /> GENERATOR S CEATIFICA N I hereby certify that the above named material Is not A hazardous <br /> waste as defined by 40 CF art 261 or We 22 of the Caftmia code o1 regulations has been property <br /> descnbed classified and jiadregod,and is In pr*W condnlon for transportation amord'rng to apPliicable <br /> regulations AND It the waste Is a treatment residue of a praviouaty restricted hazardous waato <br /> subject to the Land Disposal Restrictions I certify and warrao#rat the waste has been treated In RECEIVING FACILITY <br /> aocordance with the requirameNs of 40 CFR Part 268 and is no longer a hezardoUs waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ❑DISPOSAL O SLUDGE <br /> Q CONSTRUCTION ❑WOOD <br /> ❑ DEBRIS 0 OTHER <br /> ❑SPECIAL WASTE <br /> GENERATI G FACILITY <br /> 1876 Co4ntry Club Blvd, StocKQh, CA 95203 <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRE <br /> CITY, S <br /> N,�ffi of GFeek Rd <br /> PHONE^ ENDDUNP BOTTOM DUMP TRANSFER <br /> SIGNA RIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT=BED VAN DRUMS <br /> ❑ U ❑ ❑ <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been 18 Yards - <br /> accepted and to the best of my knowledge the foregoing DISPOSALMETHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> ❑SOIL <br /> REMARKS - <br /> ❑ CMTRUGTIdN <br /> DEBRIS <br /> FACILITY TICKET NUMBER <br /> ❑ NbWN=FRIABLE <br /> ASBESTOS <br /> ISIGN U Aid HO ED AGENT DATE WbOD <br /> j DASH, w <br /> 3 LO3 <br /> � f O SPY=CIAI.OTHER <br /> SCHEDULING MUST BE ADE PRIOR TO 3 00 PM THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> TRANSPORTER COPY_ MANIFEST 0 52924 <br />