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Lj <br /> So WL,aw+f!!! uite wx mountain u newoy �slanaI Forward <br /> h Sanitary Landfill Sanitary landfill Landfill <br /> 901 Hailey Road 2844o6affln Butte Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg,CA 94689 Corvallis,OR 97330 Half Moon Bay, CA 94019 Milpitas, CA 95035 Manteca, CA 85336 <br /> Phone(925)458-9800 Phone(541) 745-2018 Phone(850)726-1819 Phone(408)845-2800 Phone(2t}9)982-4298 <br /> Fax(925)456-9891 Fax (541)745-3826 Fax(860)726-9183 Fax(408)262-2871 Fax(209) 982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR _ <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> AMW Xatdh HORV TIM� 14 <br /> CITY STATE ZIP REQUIRED PERSONAL PROTECTIVE EQl11PNfEwl�1 <br /> CA 93304 � <br /> PHONE d GLOVES ❑GOGGLES ❑ RESPIRATOR 14b HARD HAT' <br /> CONTACT PERSON U TY-VEK C1.SAFETY VEST <br /> .Ae SPI=CIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE , / <br /> r10 <br /> GENERATaFrS CERTIFICATION:f cerfi(y Mut ft abous named gooft Is nd s <br /> are=a ae daAned by 40 CFR Part 2B1 r 22 of the CaBfamta rade of rebwa a.had q ° 1B <br /> ducrihed,aia Hied end pad agK And in in Proper carrdwn for <br /> �tlana;ANO,If the amts it a treatment reaMm of a Prarbua�ht oto e� <br /> to tfra Land the Reehk pons,I certify and mrram uvm the wvjb has heart 9,am 10 <br /> 4� l the mgWrorm*0140 CFR Pa t NO aid M no knpera ftzerciam waste.,)a died by RECEIVING FACILITY <br /> WASTE TYPE: <br /> OSAL 0 SLUDGE <br /> 0 CONSTRUCTION O WOOD <br /> O DEBRIS U OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 20M HoIA Hoq#y Djivv ;CTRA C y <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBERI TRUCK NUMBER <br /> ` rMq <br /> ADDRESS' :�'' 7 r <br /> CITY,STATE,ZiP <br /> CA0S?At <br /> PHONE <br /> END DUMP BOTTOM DUMP TF3ANSFER <br /> S GN TURE OF AUTHORIZED AGENT OR DRIVER DATEEl <br /> ROLL-OFF 5 FLAT-13ED VAN DRUMS <br /> .CUBIC YARDS <br /> I 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. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS ❑ SOIL <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O,NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> ' ] 0 WOOD <br /> O ASH <br /> ` 4 ❑ SPECIAL OTHER <br /> LtNt MUltTa PM.TH!�R IADP3� To <br /> pAY PRION'FO tXPIrC'M ARRIVAL a ANY UNSCIIIIIIIwLlp LOQ AM 11 <br /> UPON ARRIVAL.ONOoING DAILY 16111LHRI1111=MOAT/E sCNHDULBD WITH Tlfl!! LANDFILL TM/lI11AY <br /> ..;GENERATOR COPY MANIFEST 11 �5.. <br />