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LiReiter Lan on u%;omn oulze LuvJ. feluuntaln a�awu 3.wr . •- <br /> Sanitary Landfill Landfl Sanitary Landfill -qnitary Landfill Landfill <br /> 901 Bailey Road 28972 C;utte Road 12310 San Mateo Road �1 Dixon Landing Road 9995 S, Austin Road <br /> Pittsburg, CA 54565 Corvallis, R 97330 Halt Moon Bay, CA 94019 Milpitas, CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone (541)745-2018 Phone(650)726-1818 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(925)458-9891 Fax(541)745-3826 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE N0: <br /> MAILING ADD ESS 9"5 <br /> 205W Soudi lift lkbM <br /> CITY STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> MMC&CA 95104 =LOVES ❑GOGGLES ❑ RESPIRATOR )V HARD HAT <br /> PHONE <br /> Q TY-VEK CKSAFETY VEST <br /> C N ACT PERSON SPECIAL HANDLING PROCEDURES: <br /> -AM QM <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> AERATORS CERTIFICATION:I hereby car*that ftabove named netefr Is not 8 hMADUB <br /> *606 as defined by 40 CFR Part 281 or Me 22 of the Caglomia code of reguhMns,has been pfopery <br /> deftribed,daw[W and paAaged,and is In proper condMon_for lranspoRetfon sooOWQ to <br /> 1pulrations;AND.K the waste is a tnsmrent nsldus of a.0'*VkW ly newlew heOW*adzsrdow w ssu <br /> aooa[i�w ra rwnwtBLand Dtoposal of4oc 2266 and ., rftle' nar uaste tm s'ewa dynedbr RECEIVING FACILITY <br /> 40 CFR Part 281. <br /> WASTE TYPE: <br /> ,alAPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> X0300 8OU1111 RORY Drive TRACY . <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY, STATE. ZIP <br /> 1-dtCA 95241 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ <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 /> DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> Is true and,accurate. <br /> DISPOSE OTHER <br /> ❑ SOIL <br /> REMARKS <br /> ❑ CONSTRUCTION <br /> FACILITY ACKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> EkESTOS <br /> .SIGNATURE jOF AUTWRIZEQ AdfNT D <br /> tASH OOD <br /> ❑ SPECIAL OTHER <br /> IL <br /> 66HEDULINO MU51t BE PRIOR TO 3:00 P.M-THE DAY PRIOR TO EMOTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUI'ti M <br /> TO REFUSAL UPON ARRIVAL.ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> Ray 11/09 NS-024 GENERATOR COPY MANIFEST 4 .� <br />