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<br /> Sanitary Landfill Landfill y �olr►natrd " '
<br /> Sanitary Landfill unitary Landfill Landfill
<br /> 901 Bailey Road, 289721 Butte Road 12310 San Mateo Road 01 Dixon Landing Road. 9999 S. Au8iiil Road
<br /> Pittsburg, CA 94565 Corvallis, R 97330 Half Moon Bay, CA 94019 Milpitas, CA 950350
<br /> Phone (925)458-9800 Phone (541) 745-2018 Phone (650) 726-1819 Phone (408) 945-2800 Pi one�(29) 9C,2-/4296 s8
<br /> Fax (925).458-9891 Fax (541) 745-3826 Fax(650)726-9183
<br /> Fax(408)262-2871 Fax (209)
<br /> NON-HAZARDOUS WASTE MANIFEST
<br /> GENERATOR I .___
<br /> S, f:dXh SURrIf WASTE ACCEPTANCE NO,
<br /> MAILING ADDRESS
<br /> t�iif?Bv�ari}e} sty 7re
<br /> CITY, STATE, ZIP
<br /> REQUIRED PERSONAL PROTECTIVE EC�iJII�h. ���
<br /> . JCA R3304 � --
<br /> PHONE it IIGLOVES ❑ GOGGLES ❑ RESPIRATOR NJ HARD HAT l
<br /> 4.7 O'TY-VEK IN SAFETY VEST
<br /> CONTACT PERSON
<br /> Ant — SPECIAL.HAN LING PROCEDURES:
<br /> SIGNATURE'OF.AUTHORIZED AGENT 1 TITLE DATE
<br /> -,` r• /' z
<br /> GENERATOR'S CERTIFICATION:I hereby certify that the abov amed meeriaf rs not a FiazaFtleus
<br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regufalions,has been property
<br /> described,classified and packaged,and is in proper condition for transportation accar&ng to appiicable
<br /> regulations;AND,If the waste Is a treatment residue of a previously restricted hazardous waste '
<br /> subject 10 the Land Disposal Restrictions,I certify and warrant that the waste has been treated in --
<br /> accordance with the requirements of 40 CFR P57,.268 and is no longer a hazardous waste as dfined by RECEIVING FACILITY —
<br /> 40 CFR Part 261. •
<br /> WASTE TYPE: --
<br /> 0 DISPOSAL ❑SLUDGE
<br /> ©CONSTRUCTION ❑WOOD " Y s"
<br /> ❑DEBRIS' 13 OTHER
<br /> 13 SPECIAL WASTE
<br /> GENERATING FACILITY
<br /> IR-Ily TRACY
<br /> TRANSPORTER 1,
<br /> innm of i
<br /> NOTES: VEHICLE LICENSE NUMBER TRIJIQX NUMBER
<br /> -
<br /> ADDRESS
<br /> :..
<br /> CITY, STATE, ZIP;
<br /> I_2LCA'95 2 41
<br /> PHONE END DUMP BOTTOM DUMP TRANSFER
<br /> f t _•i 9 it ❑ J
<br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS
<br /> 4
<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. DISPdSAL METHOD: (TO BE COMPLETED BY LANDFILL)
<br /> DISPOSE 011-1ER
<br /> REMARKS '❑ SOIL
<br /> �•
<br /> ❑ CONSTRUCTION
<br /> FACILITY TICKET NUMBER DEBRIS j •
<br /> ❑ NON-FRIABLE ;
<br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS
<br /> w..._. ❑ WOOD
<br /> 1 ° ✓� ��-�,. �' r'` / ❑ ASH
<br /> ❑ SPECIAL OTHERpN
<br /> x SCt1EDt1LIi1�G.MUS'!'B .{4IAIDE PRIOR T�3 D0 M TFIE QpY PIiBO 70 EXPECTED A,R�IVi4L .ANY llltlS a1EDULIED LOADS Ak StlBJECT .
<br /> �T�I�EUSAI.UPOPI ARRIVAL OAIGOIIde DAILY DLIVEI1iES CIAUST RE SCHEpULD{MITH TIiE`LAND [LL TIKE DAY REFOR(E
<br /> {.; R,> 4 c 3;S 0244,e : ',. } - Y� '`•. + ,�,,-:GENERA�'OFI COPY y .�, _ MANfFEST#sE+'",'� ^�*�;4i� . T;` ,
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<br /> -' .. � ._ a .^«,.F-.5.,is_`r. ._�,t.§t xa- ,t :,tlyy'z ...,<iv, .>,.+a..�,'„e•. ,.e.i0.E ,�,<Li1�.,. ..c�Y t...W.car�
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