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LJ1%V11er an on u[:orrin tjuite LI Ox Mountain LJ Newby Island jfl Fol'ward Sanitary Landfill Land' Sanitary Landfill Ianitary Landfill Larld ill 901 Bailey Road 28972 Gb1rin Butte Road 12310 San Mateo Road X01 Dixon Landing Read 9999 S. Ausiir,Poad Pittsburg, CA 94555 Corvallis, OR 97330 Haff Moon Bay, CA 94019 Milpitas, CA 95035 Manteca. CA c;51,30 Phone (925) 458-9800 Phone (541) 745-2018 Phone (650) 726-1819 Phone (408) 945-2800 Phone �L2.4193 Fax(925) 45B-9891 Fax(541) 745-3826 Fax (650) 726-9183 Fax (408) 262-2871 Fax (90,D) °51,,-1009 NON-HAZARDOUS WASTE MANIFEST GENERATOR WASTE ACCEPTANCE N0. MAILING ADDRESS — �. x CITY, STATE, ZIP REQUIRED PERSONAL PROTEC-11VE PHONE GLOVES U GOGGLES Ll RESPIRATOR 001?-P Vic:?x•`76'7 ' U TY-VEK C7 SAFETY VEST CONTACT PERSON _ s?r7eiti:r„ ,rr-;a SPECIAL HANDLING PROCEDURES: SIGNATURE OF AUTHORIZED AGENT 1 TITLE DATE -GEf•IERATOR'S CERTIFICATIOrA:I hereby L:0'Illy that the abcve named maleiial is of a hazardous wasle as defined by 40 CFR Pari?M1 or title 22 of Itla Calffornla code of regulations,has been properly described,classified and packaged,and is in propsr condition foi transportation according to appilcebfe regnlatlons;ANO,If the waste Is a trealmegl residue of a previously restricted hazardous waste subiecl 10 tiia Land Dspnsel Restrictions,I certify and warranl thal the waste has been Ireated ib RECEIVING FACILITY accordance wilh the requirements of 40 CFR Part 298 and is no longer a hazardous wasialas daAned by 40 CFR Part 251. WASTE TYPE: , 'flfSPOSAL w '' — ' GE :' A .. T— ''�❑CONSTRUCTION R WOOD -- ❑DEBRIS ❑OTHER –— — - _ U SPECIAL WASTE GENERATIN 9G FACILITY i.r,4A�, TRANSPORTER L NOTES: VEHICLE LICENSE NUMBER TRUCK IlkJMBFR ► 5�'par��Ts ,Il wox; -- ADDRESS2, CITY, STATE, ZIP PHONE ---------- END DUMP BOTTOM DUMP SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VANDF;tJIvl„ C,P 77 7-1 CUBIC YARDS I hereby certify that the above named material has been — accepted and to the best of my knowledge the foregoing is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LAIIDl-}LL) DISPOSE C1`l itcP. REMARKS ❑ SOIL ❑ CONSTRUCTION FACILITY TICKET NUMBER DEBRIS r U.NON-FRIABLE SIGNATURE;OF AUTFIORIZED AGENT GATE ASBESTOS - ❑ WOOD j i _U ASHf ' 1 SPEbAL OTHER SCHEDULING MUST BE MAI?k PRIOR TO 3:00 P.M:THE DAY PRIOR TO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT TO REFUSAL UPON.ARr614AL.ONGOING DAILY DELIVERIES MUST 139 SCHEDULED WITH THE LANDFILL THE DAY,OfFORE, Rev 11/09 N5-024 i;/ s'= GENERATOR COPY MANIFEST# rz