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- �•�,��� %.attyll Liill 13utte ❑Ox Mountain ❑Newby Island Forward <br /> Sanitary Landfill Landfill Stnitary Landfill S_� `try Landfill Landfill M <br /> 901 Bailey Road 28972 Coffin Q,,Road 12310 San Mateo Road1601`[tixan Landing Road 99995.Austin Road <br /> Pittsburg, CA 94565 Corvallis, OR 97330 Half Moon Bay, CA 94019 Milpitas, CA 95035 Manteca,:CA 95336 <br /> Phone (925)458-9800 Phone (541)745-2018 Phone (650)726-1819 Phone (408) 945-2800 Phone (209) 982-.4298 k <br /> Fax(925)458-9891 Fax(541) 745-3826 Fax(650) 726-9183 Fax(408)262-2871 FW!'(209)-982-1b09 I <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> 20500 Mmffi notly Drive — [�9a <br /> 3 <br /> CITY, STATE, 0 REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 3 <br /> PHONE =LOVES 0 GOGGLES ❑ RESPIRATOR 3D HARD HAT <br /> .❑TY-VEK LXSAFETY VEST ' <br /> CONTACT PERSON <br /> Ame0my <br /> SPECIAL HANDLING PROCEDURES: T <br /> SIGNATURE OF AUTHORIZED AGENT 1 TIT E DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above n mad materia!is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properly <br /> described,classified and packaged,and is in proper condition for'transportatlon according to applEcable <br /> ,regulations AND,it the waste Is a treatment residue of a previously restricted hazardous waste �- - <br /> sublecl io the Land Disposal Restrictions,I certify and warrant that the waste has been treated In RECEIVING FACILITY <br /> -'S accordarioe+with the requirements of CFR Part 2 68 and is no longer a hazardon_s waste as defined by - <br /> CFR Part 261. _ <br /> WASTE YPE:. �3 ' <br /> ISPOSAL ❑SLUDGE y � <br /> *CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE-; <br /> GENERATING FACILITY <br /> 20500 Stout&.Holly Drive TRACY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> A—Thome Oil Ime <br /> ADDRESS <br /> P4)d Office 0-sr-357 <br /> CITY, STATE, ZIP <br /> w <br /> PHONE END_D_UMP __ BOT_T_OM_DUMP__ _ TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE R LL-OFFS FLAT-BED = VAN DRUMS <br /> CUBIC YA S <br /> I ; <br /> hereby certify that the above named mal-te' riall has been <br /> accepted and to the best of my knowledge the foregoing <br /> IS true and accurate. DISP S METHOD: (TO BE COMPLETED BY LANDFILL) w <br /> DISPOSE OTHER <br /> REMARKS ❑ SOIL <br /> E) CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ N N-FRI BLE <br /> A BEST S <br /> SIGNATURE PF AUTHORIZE AG <br /> OOD <br /> I <br /> r' ❑ H <br /> ❑ All OTHER <br /> i <br /> SCHEDULING MUST BE MADE PRIOA T 3;00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUB.lECT <br /> TO REFUSAL UPON ARRIVAL.10130blll DAILY DELIVERIES MUST.BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. i <br /> Rev 11109 NS-024 GENERATOR COPY MANIFEST#.96,1 <br /> � r <br />