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Sanitary Landfill Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 2897' ft' Butte Road 12311 San Mate6 Aoad 1601 Dixon Landing Road 9999 S. Austin Road <br /> Pittsburg,CA 94565 COrt OR 97330 Half M66n flay CA'94019 Milpitas, CA 95035 Manteca,CA 95336 <br /> Phone (925)458-9800 Phone (541)745-2018 Phone(650)`,x'26.1819 Phone (408)945-2800 Phone(209) 9824298 <br /> Fax(925)458-9891 Fax(541) 745-3826 Fan(650)~726-9183 Fax (408)262-2871 Fax(M)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADD ESS <br /> WOO Stat Raft Drive 94.01 14 <br /> CITY, STATE, ZIP REQUIRED PERSONAL. PROTECTIVE EQUIPMENT <br /> 0A 9,S304 <br /> PHONE XGLOVES ❑GOGGLES ❑ RESPIRATOR 31 HARD HAT <br /> Q TY-VEK IKSAFETY VEST <br /> -CON ACT PERSON <br /> film SPECIAL HANDLING PROCEDURES: <br /> .SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> * 2 <br /> G NERATOR's CERTIFICATION:I hereby cerefy dwt the SbWnarnd matelot 6s not a haaardous <br /> waft as defined by 40 CFR Part 261 or ft,22 of the CalMomia code of nyuletlans,has been r ady <br /> deeat t4 tdamOW and pndmggd,and is in proper oendflan lar transportation aceerdhg b eWlcabie <br /> regldaftw;AND,.ff the whale isa treatment residue of o pmoaualy,"b bbd hazwdom waaM <br /> �w�� is of 40 PR Part��Is no at Me waaM hoe been treated a RECEIVING FACILITY <br /> SO CFR Part 261. forger a hazardous waft e s defined by <br /> WASTE TYPE: <br /> Q DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION Q WOOD y <br /> la DEBRIS Q OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> 205M Boullit Ho*Dnve TRACY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY'STATE, ZIP <br /> 4'A 95241 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ L) <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS J <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to the best of my knowledge a the foregoing <br /> DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL <br /> Is true and accurate. ) <br /> DISPOSE OTHER <br /> REMARKS o SOIL <br /> ❑ CONSTRUCTION ' <br /> FACILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT ' DATE ASBESTOS ; <br /> Q WOOD x : <br /> ❑ ASH <br /> O SPECIALOTHER <br /> $W1 DU10kd*� ST ME MADE PRIOR'r0 a-oo P.IIA.TIiILt DAY I IIIdR T liI�PEOTEQ ARRIVAL-ANY U"00" <br /> TO RSFUSAL IPPON ARRIVAL.ONaoM'- G DAILYBEA.11�ltIX.S 1NOT BE SCHROULIED WITH TH&i.A" <br /> seg t troe NS-024 Q )\IEg 'rO CORY MAfVtI C#I , <br /> �r <br />