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LSI vA nrarareILaler U rwnruy 161difu I"Or'nror�a <br /> Sanitary Landfill Landfill' 1t1` Landfill. oanita Landfill <br /> sol salla Road ! ' ry Landfill <br /> Y 28972 Curr Butte Road 12310 San Mateb Roads �1 Dixon Landing Road 9999 5,�AuOn Road <br /> Pittsburg,CA 94565 Corvallis,OR 97330 Half Moon Bay,CA 9401 9 Milpitas,CA 95035 i�inlqca'CA <br /> Phone (925)458-9800 Phone(541)745-2018 Phone(650) 726-1819 ° :. Phone(408)945.2800 'PhbhW—(209 98229E <br /> Fax(925)458-9891 Fax(541) 745-3826 Fax(650)728.9183 Fax(408)282.2871 Fax(20( } <br /> 9)989�1oQ9 <br /> NON-HAZARDOUS WASTE MAIWFEST <br /> GENERATOR <br /> WASTE ACCEPTANCE W), <br /> MAILING ADD ESS <br /> CITY STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 93304 <br /> PHONE [CLOVES WPOGGLES ❑RESPIRATOR &HARD HAT <br /> ACT PERSON O TY-VEK ISSAFETY VEST <br /> O SPECIAL HANbLiNG PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:Ecertlfy that qri ttbave rtsrned ntaterlel Is nat e'. <br /> wdef*d by 40 CFR Pad 2s or 22 bt lie Co fa is coda of rsyiMlom,has,;;D.oan phVerty <br /> dooMtbed;da�Aed and .-W is h proper Am dto hanapmmm W—ft AND,M the a�rreraebrreut raatdus of a prsvf-*r r-VW@d heeer&w arasts <br /> Ihe':L and bt•pc•el Reatdotkme,t osrdfy end warrwd IM the waste tree been treMed h <br /> raqulrenra....of 40 CFR Part 25a and b no kerpar a hezankm waatep d ad by RECEIVING FACILITY <br /> RE• . <br /> •:DISPOSAL <br /> ❑CONSTRUCTION ❑SLUDGE <br /> , ❑WOODS <br /> O DEBRIS ❑OTHER <br /> ©SPECIAL WASTE <br /> GENERATING FACILITY <br /> 4"300%U&H*Ilxivt* TRACY <br /> TRANSPORTER NOTES: VEHICLE LICENSE,IYUMBER TRUCK NUMBER <br /> ADDRESS: . r, <br /> CITY, STATE,ZIP <br /> 324 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> M t� <br /> S GN TUBE OF AUTHORIZED AGENT OR DRIVER - DATE ROLL-OFF 5 FLAT BED VAN DRUMS <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and,to the beat of my knowledge the foregoing <br /> IS true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) - <br /> DISPOSE OTHEFI <br /> REMARKS a SOIL <br /> O CONSTRUCTION <br /> FACILITY TdCKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> SIGNAT AE' F AUTH IZED A. ENT DA ASBE TOS <br /> W D <br /> o s iE CtAL 6THER <br /> MII1 ft d1[M1t PRI TD 3,00 P:M: <br /> 1`IIE IVAL•ANilf 1lNlCMEDUfXD LOADsi'AM bill bT <br /> �I F11t;/1L IIIPONAIIRiIi L. 1000091 DAILY Dst'.tV 1 R <br /> Beit t 1 DRbW.LBp 1(YI'1N iii1 LANDFILL TNe DA I��QIRI . <br /> t4S 0124 fN ! Y <br />