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WA <br /> y . + r�SanitarytLandfill u Ranitary�Landfill Laid�iill� <br /> Sanitary Landfill' Landfill. <br /> 901 Bailey Road 28972 Butte Road 12310 San Mateo Road 1 Dixon Landing Road 9992 S. Austin Load <br /> Pittsburg, CA 94565 Corvallis,�Ft 97330 Half Moon Bay, CA 94019 Ilpitas, CA 95035 Manteca, CA"5336 <br /> Phone (925) 458-9800 Phone (541) 745-2018. Phone (650) 726-1819 Phone (408) 945-2800 Pylon. 203 9K-42 <br /> 98t(925) 458-9891 Fax(541) 745-3826 Fax (650) 726-9183 Fax(408) 262-2871 Fax (20-J) iC09s8 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR — - <br /> c l , WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY, STATE, ZIP REQUIRED PERSONAL_ PROTECTIVE EQtIIF'f� EL"1 <br /> TMCY 10A3l1 <br /> PHONE ��1 Iff•GLOVES ❑ GOGGLES ❑ RESPIRATOR XQ HARD HAT <br /> 7679 J! <br /> YE1 TY-VEK 0SAFETY VEST <br /> CONTACT PERSON _ <br /> r3i<a0e;:) SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT 1 TITLE PATE <br /> G>NEAATOA'S CERTIFICATION:r hereby certify that the above named material is not a hazardous ` <br /> waste as defined by 40 CFR Part 269 or title 22 of the California cede of reguiations,has been properly <br /> described;dlassified and packaged,and is in proper condition for transportation according to applicable <br /> rAgu4tEd6s;.AM6j.lVlhe waste is a treatment residue of a previously restricted hazardous waste <br /> 4O'GFR.Pa � <br /> gubfec0&the 68'nd1Dis dsal Restrictions,I certify and warrant that the waste has been treated in <br /> requirements of 40 CFR Pwt,N8 and Is no longer a hazardous waste as de�medby RECEIVING FACILITY <br /> ty"281:.: _ E <br /> WASTE TYRE-. <br /> POSAL e„, a - ❑SLUDGE _ <br /> Q CONSTRUCTION El WOOD <br /> C3 DEBRIS ❑OTHER <br /> 4 SPECIAL WASTE V I <br /> f r <br /> GENERATING FACILITY <br /> 21� 41i1c �lSr� M.A;C"'Y <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Jim oij Inc, ' <br /> ADDRESS <br /> CITY, STATE, ZIP f <br /> "i^ <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE R -OFFS FLAT-BED VAN DRUMS <br /> rp' CUBIC YARDS I <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. DISPOSAL MOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS ❑ SOIL <br /> �+'-'-- ❑ CON5TRUCT�ON <br /> FACILITY TICKET NUMBER DEBRIS <br /> i ❑ NON-FRIAB <br /> SIG ATU E <br /> ASBESTOSI <br /> ., QF ALl'THORIZED GENT DATE <br /> / ❑ OOD <br /> CASH <br /> ff <br /> ' P SPECIAL&HER — .k <br /> !. Yi ..� <br /> Sdhtb 1t 4 MUST RE. ALAE; RIOR TO 3.00 R.M.THE DAY 0RlOR TO EXPECTED ARRIVAL•ANY UNSCHEDULED LOAD$ARE SUBJE& <br /> WO <br /> TQ REIFUSAL`UI�OM` RI�A11..OOINia�'OAILY bELIIVkRIES`MUST BfE.SCHEDULED WITH THE LANDIPILL•TWE DAY BEFORE, <br /> � <br /> Rev l l/oa N5 024 3 ,> GENERATOR COPY MANIFLST 9, �� <br />