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mallma[ JLanaTlll Landfill sanita i y Landfill Sanitary Landfill Landfill. <br /> 901 Bailey Road 284"-Coffin Butte Road ` 123101ban Mateo Road 1601 Dixon Landing Road 9899 S.Austin.Road <br /> Pittsburg, CA 94565 Co OR 97330 Haff Moon Bay,CA 94019 Milpitas,CA 95035 Manteca, CA. 95„38 <br /> Phone(925)458-8800 Phone(541) 745-2018 Phone(650)726-1819 Phone(408)945-2800 Phone(209)992-4290 <br /> Fax(325)458-9691 Fax(541)7453826 Fax(650)726-9183 Fax(408)262-2871 Fax(2209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> ILING ADDRESS <br /> WASTE ACCEP7°ANCE NO. <br /> MA <br /> �ASW 9914 4 <br /> CIT' STATE ZIP REQUIRED PERSONAL PROTECTIVE E(�UICPhEtT <br /> '11re1:•CA.95304 <br /> ONE EIGLOVES U GOGGLES 0 RESPIRATOR 3t HAH0 HAT <br /> CONTACT PERSON ❑TY-VEK !$SAFETY VEST <br /> ''=e SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GEN AMM'&Cr RnF'ICATM 11�re cartlfy I N Iha above named trtaw"it not a hrz ploprrly <br /> wqt n .ak=i bS'&CFR Part 291 w Wfs p al tlM Ca Umf w-amli l n bfs <br /> :dtleal6ad,olaeailled and pedoapad,and to h P aanstllon Ior' <br /> £`rapuMtlane;AND,M Ida I= Is a VesbrtM reaMw of a pnvlopaty raaglclad a wart <br /> 1b appka <br /> auhfad t tha Gud t]hpfesl ReaW�ltona I faddy end WA"M Thal ft waste has than homed in <br /> 40 C R" 28,�e of 40 CFR Part 200 snd Is no bngera ia�zerdaua waft as dfinsd by RECEIVING FACILITY <br /> WASTE TYPE: <br /> P-DISPOSAL ❑SLUDGE <br /> Q CONSTRUCTION O WOOD <br /> •DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 20M 89wh Holly OTBACY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK Nttlw_B R <br /> ADDRESS A <br /> CITY, STATE, ZIP <br /> CA 9$241 <br /> PHONE <br /> END DUMP BOTTOM DUMP TRANSFER <br /> S GN TUBE OF A''UTHORIZED AGENT OR DRIVER DATE �. © 0 <br /> ROLLOFF S FLAT-BED VAN DR;IMS <br /> 0 0 Q <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 /> I8 true and accurate. DISPOSAL METHOD: (TO BE COMPLETED W LANDRLL) <br /> DISPOSE OTHER <br /> REMARKS ❑ SOIL <br /> a CONSTRUCTION <br /> FACILITY TICKET NUMB DEBRIS <br /> ' Q NON-FRIABLE <br /> SIGN RE O TAUT RIZ AGE T DTE_ ASBE- O,s, <br /> f F �r rF W D f l Lit <br /> ►] SPECIAL OT14ER <br /> `NI!DUWNO MUST dE IOR TO SIM P.MI1.THE DAY PRIOR TO PJIP�CTlD AIIRIVAL a' ANY IINtICM#DULHD LOAIK AW11 ; <br /> '!r'Q RR�UlAL UPON AR MV L.ONOOINO DAILY DELIVIBRIIE!MUST 21 WHEDULRD WITH THE LANDMLL THE DA.' 2" � 4 <br /> Rev 11!48 N"24 ti ` <br /> GENERATOR COPY MANIFEST ` t <br />