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..... .v,r 1 1VVlflt�I�uiie x oun am Ll Newc� r Newby Island ,�1� ��trarct Sanitary Landfill Landfill +Sanitary Landfill 7anitary Landfill Landfill f 901 Bailey Roaa 28972 U1 Butte Road 12310 San Mateo Road 01 Dixon Landrig Road Pittsburg, CA 94565 Corvallis, OR 97330 !3 9999 S: ',�IsEiri road Halt Moon Bay, CA 94019 Milpitas CA 95035 MantVca, CP, 03336 Phone (925) 458-9800 Phone (54.1) 745-2018 Phone (650)726-18119 Phone (408) 945-2800 Phone (208) 932-4298 Fax (925)458-98.91 Fax (541) 745-3826 Fax(650)726-.9183 Fax (408)262-2871 Fax{209) 982.1009 NON-HAZARDOUS WASTE MANIFEST GENERATOR — Sh WASTE ACCEPTANCE NO. ) MAILING ADDRESS 20590 South Holly 1),rive CITY, STATE, ZIP ` .07 REQUIRED PERSONAL PROTECTIVE EQ fFETR'Pf T-tw�I.CA,9 304 f. --- PHONE §GLOVES ❑GOGGLES ❑ RESPIRATOR b HARD HAT ('203)934-7079 ❑TY-VEK JSAFETY VEST CONTACT PERSON Anne SPECIAL HANDLING PROCEDURES: SIGNATURE OF AUTHORIZED AGENT/TITLE DATE GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a haza;06us waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property described,classified and packaged,and fs in proper condition for transportation according to applicable regulations;AND,If the waste Is a treatment residue of a previously restricted hazardous waste subject to the Land Disposal Restrictions,1 certify and warrant that the waste has been treated in -- ---- I .accordance with the requlremenls of 40 CFRrpart 258 and is no longer a hazardous waste as d ifined b RECEIVING FACILITY — 40 CFR Pad 261. :r y WASTE TY IE-. — .�' 0 SLUDGE p" O CONSTRUCTION ❑WOOD --- ❑DEBRIS Q OTHER -- 0 S�ECIAL.,WASTE GENERATING FACILITY TRANSPORTER � :..:•��'��;'a...r;>: NOTES: VEHICLE LICENSE NUMBER TRUCK klUlvv _R .IM` h , e Oil Inc. a — — ADDRESS CITY, STATE, ZIP O&f~ A 95241 PHONE END DUMPQ5Q)t 111%,SARI BOTTOM DUMP l Hl-',f 1 F I SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL OFFS FLAT-BED VAN DRUMS CUBIC YARDS ^---__ hereby certify that the above named material has been` , accepted and to the best of my knowledge the foregoing is true and accurate. DISPOAl METHOD: (TO BE COMPLETED BY LANDRI_L) ` ti DISPOSE OTHER, REMARKS C3 SOIL Ef CONSTRUCTION FACILITY TICKET NUMBER DEB9IS.- "f`16N-FRIBLE SIGNAT `RE , F AUT 091ZED AGENT f'. -DATE y ASBEST S i 1 7 II !. 0 WOOD � 4 p - 7 0 SPECIAL:'OTHE -ScHebtiONG MUST BE MADE ORIOR TO 3:00 P.M.THE DAT PRIOR TO k0idTED ARRIVAL.ANY UNSONEDULOD: LOADS ARE SUBJECT ! TO REFUSAL UPON ARRIVALAONG61ING DAILY DELIViRIES,M ST BE SCHEDULED WITH THE LANDFILL THE DAV.BEFORE. Rt3v 11179 NS-024 # % Off GENERATOR DOPY MANIFEST ' # .�€ y