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_-- -- _1441111 Sanitary Landfill. Sanitary Landfill Landfill <br /> 901 Bailey Road 289"Coffin Bute Road `12310$®n Mateo Road 1601 Dixon Landing Road <br /> 9699 S.Pittsburg. CA 94565 Co�,OR 97330 Half Moon Bay,CA 94o19� Mllp#tas,CA 95035 MantecdACAt95336d <br /> Phone (925)458-9800 Phone(541)745-2018_ Phone(650)726-1819 Phone(408)945-2800 phpng.(2gy)'98�-429t <br /> Fax'(925)458-9891 Fax(541)745-3826 Fax(650)726-9'183 Fax(408)262-2871 Fax(209)982-1008 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> `4 WASTE ACCEPTANCE N4. <br /> ` N ADDRSS: <br /> I3 — .1[ <br /> STATE"ZIP REQUIRED PERSONAL PROTECTIVE EQUtPfr1=AJT <br /> 9 , <br /> N IXGLOVES ❑GOGGLES ❑RESPIRATOR XJ HARD HAT <br /> ACT'`PERSON L1TY-VEK 12 SAFETY VEST <br /> SPECIAL HANDLING PROCEDURES: <br /> IaNATURE OF AUTFdORIZED AGE fr/TITLE... DATE <br /> AN by4040Pittt i t eboy�nimi mat"Is nm a hsukkk�y <br /> I ,claesil CFA 2d1 gNl �4de 4t rapulepera,hes <br /> PSL■ end f! ab4tlltlorr ftli <br /> fha L eridlNw�° hawdme <br /> i ce�1y a1�alwa�mnr nret use wash nss bean treated In RECEIVING FACILITY <br /> .t the ran+.ob d 4o CSR p�2ae and!s na monger a hezerdoiw crash as mw by <br /> *E:TYPE: <br /> 090 SAL 13 SLUDGE r* <br /> CONST RUCTION O WOOD <br /> d C}EBRIS ❑OTHER <br /> "'•, ❑SO'JAL WASTE <br /> E. ERATING.FACILITY <br /> r .. <br /> :. .SPORTEIj NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> pbRESSa <br /> *h <br /> IrY,, srArE,zIP <br /> CA 93241€ <br /> HONE <br /> END DUMP BOTTOM DUMP TRANSFER <br /> Et <br /> NATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS— <br /> CUBIC <br /> UM5CUBIC YARDS <br /> l hereby certify that the above named material.has been <br /> �,accepted and:to the best of my knowledge the foregoing <br /> Is true and accurate. D SOOSAI METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE O"I"HLH <br /> REMARKS 0 SOIL <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> V NON-FRIABLE <br /> SIGNAT RE;OF AUTHORIZED AGENT •DATE ASBESTOS <br /> �i <br /> U WOOD <br /> ❑ H <br /> t' <br /> O 1PECIAL OTHER <br /> ., - •. 1. <br /> IlilO t IPI{ p TO 4806 p.M.TH�DAY PIlI( I,t ARI1IVAL•ANY UN1lC IRDUIkEb LOAD/A11R <br /> �FUsI♦AL' N00�10 IDAIL�DaaLIV�11is�rwU�"y■�flf NllbVkllD WITH TfNe t.AI�DEILL rt14tl X11 <br /> E /� xj rid <br /> F S i - Qi`NIYIA"t' i f <br /> QjI�COPY NiAK1lFF$t� <br /> .. , .r.:'• .. ,:., .. . s.:� ..v. -.orY:fin•,�;,V�v�}l� ,.,x-, s.'i, ...a : .. .... r.x...jA::fil$la?R4:.6,u7t;(�'�'G+'�e'' L -. $'N�...' <br />