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Sanitary Landfill Landfill Sanitary Landfill Sanitary Landfill LE�i�Ifill <br /> 901 Bailey Road 28 offin Butte Road '12310 San Mateb Road 1601 Dixon Landing Road S.Austin Road <br /> Pittsburg, CA 94565 COrMWOR 97330 Half Moon Bay,CA 94019 Milp€ts,CA 95035 Mardeca,CA 35338 <br /> Phone(925)458-9800 Phone(541) 745-20V; Phone(660)728-1819 Phone(408)945-2800 Phone.(2(01982-4298 <br /> Fax(925)458-9891 Fax(541)745-3826 Fax(650)726-9183 Fax(408)282-2871Fax(209)582-1049 <br /> NONHAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> WASTE ACCEPTANCE N0: <br /> MAILING ADDRESS ��� <br /> QSUDr Ilia Axlv+~ <br /> CITY, srATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMEMT <br /> TMV.CA,2SI94 <br /> PHONE (10LOVES O GOGGLES U RESPIRATOR )b HARD HAT <br /> LM <br /> CONTACT PERSON 0 TY-VEK 4f SAFETY VEST <br /> Afte SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR`S CERTIFICATM7R:I hereby oe ft Midi Mw shove named m add, to W a baa <br /> wale=-daMnsd by 40 CFR Part2ef or BMe 22 aI Mw CalMomra coda of ropdkUma,l7ee bun piap" <br /> deaalbedi C MOMad and pedraged,arW Is In proper condMon hx hao mimbn acoorrllnp to appleaple <br /> 4ANq N the watae h a traed}7a7t raeldua of a prevkPj*raaVbbed harardoue waa s <br /> 7a lard bbpmd peeMdbM I em"and waranl dud the"sle has been Wukd M <br /> MN POW&Smanle x140 CFR Part=and to no WW O hwudoes weeta.,drw by RECEIVING FACILITY <br /> 281. <br /> WASTE TYPE: � <br /> ,WOISPOSAL 0 SLUDGE r <br /> O CONSTRUCTION ❑WOOD <br /> ❑DEBRIS 0 OTHER <br /> O SPECIAL WASTE, <br /> GENERATING FACILITY <br /> MW&M&Bony DIe+M TRACY ' <br /> Eill <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMHER TRUCK NUMBER <br /> Jim <br /> ADDRESS <br /> f <br /> ZIP <br /> OA 93241 <br /> DNE END DUMP BOTTOM DUMP TRANSFER <br /> 1320-3421 L3 Q <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT BED VAN DRUMS <br /> y O © ❑ <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. kDlSPbSAETHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> W1=MARKS O SOIL <br /> Q CONSTRUCTION <br /> FACILITY TICKr=T NUMBER DEBRIS <br /> 0 NON-FRIABLE <br /> SIGNATUR OF AUTHORIZED AGENT DATE --MB STOS <br /> 7` r ❑ S ECIAI_ THER <br /> SDIIL�DULING MUST iSIE MADE PRI"TO P.M.THE DAY Pp1OR TO EX CTS ARRIVAL•ANY.UNSCHEBULII;D LOADS ARE Sgbj.Eff <br /> YO E =AL UPON ARRIVAL.QT"1443 NO DAILY IMLIVERIEA.MUST BE SCHEDULED WITH THE LANDFILL THE DAY barboo.t <br /> 5s R 11/0!1 MS 024 GENERATOR.COPY MANIFEST#...* <br />