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'"•• "•• uL.vtmt ouii@ BIUX Mountain U Newby Island '° Forward <br /> Sanitary Landfill Landf;'t Sanitary Landfill � ysanitary Landfill' ` Landfill <br /> 901 Bailey Road 28972 1 �—a+6 <br /> Butte Road 12310 San Mateo Road 01 Dixon Landing Road 9999 S. Austin Road <br /> Pittsburg, CA 94565 Corvallis, OR 97330 Haff Moon Bay, CA 94019 Milpitas,CA 95035 -Manteca, CA 95336 1 <br /> Phone (925)'458-9800 Phone (541)745-2018 Phone(650) 726-1819 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 t <br /> WASTE ACCEPTANCE NO, <br /> MAILING ADD ESS E�E� - . <br /> 20500 South HoLJV i7jirre <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> TkWCy,CA953Q4 <br /> PHONE [ IXGLOVES U GOGGLES ❑ RESPIRATOR M HARD HAT <br /> CONTACT PERSON 0 TY-VEK LXSAFETY VEST 1 <br /> emote dJ SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE-.'. AUTHORIZED AGENT/T1TLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material Is not a hazardous <br /> waste as defined by 40 CPR Part 261 or title 22 of the California code ofregulations,has been properly <br /> _'des&fbdd;classified and packaged,and Is in proper condition for transportation according to applicable <br /> `'regillatfons; <br /> AND,If the,waste Is a treatment residue of a praviouaiy restricted hazardous waste <br /> ub(actto'the Land Disposal Restrictions,I certify and warrant that the waste has been treated in <br /> a0corda'nUe,with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as dgfined by RECEIVING FACILITY <br /> 44 CFR Part 261-. <br /> WASTE TYPE:' <br /> O DISPOSAL O SLUDGE <br /> CI CONSTRUCTION>. 0 WOOD; <br /> a D DEBRIS U OTHER <br /> rQ SPECIAL WASTE <br /> GENERATING FACILITY <br /> 20511M gouOi Rtfiy Asa-ve TRACY <br /> TRANSPORTER '' NOTES: VEHICLE LICENSE NUMBER TR CK NUMBERqmwi <br /> ADDRESS ,+ <br /> CITY :flAIU, P' <br /> PHONE END UMP BOTTOM DUMP TRANSFER <br /> 51GNATUREOF AUTHORIZED AGENT OR DRIVER DATE ROLL- FF(S AT-BED VAN DRUMS <br /> 9 //F ❑ o © o <br /> ��'J. t. P�!•'/t.' { icy! fs - <br /> rr t I <br /> CUBIC YARDS <br /> 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 METHOD: . (TO BE COMPLETED BY LANDFILL) <br /> +1+. DISPOSE OTHER <br /> REMARKS, 0 SOIL'. <br /> ' Q CONSTRUCTION <br /> FACILITY Tf ET NUMBER DEBRIS <br /> 0 NON-FRIABLE <br /> �- <br /> 51GNATU OFA HOR !=D A EENTA5 ESTO <br /> (DAT I <br /> 0 PECIAL OTHER <br /> I <br /> E= SONE®ULIIVG MUST SEE MADE PRI O 3:00 P.MI.TIIEL DAY RIiIOR.TO EXPECTIEE�ARRIVAL.ANY t1 ISCHEDULED LOADS ARE StiWtCT" <br /> YO RECUSAL UEP® 1 ARRIVAL. 1f C,OINQ DAlLY'DIELIVEERIiE;�MAST BE SCNR®UL D WITD1 TlIfE LANDFILL TI .E DAY.BEFOFIIE. <br /> � F�ev 17109 iyS,t724 .. , ..MANIFEST# ^ � r <br />