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,, twuy A�i[tif1U X .rtJrwaru " Sanitary Landfill Landfill Sanitary Landfill Ranitary Landfill Landfill 901 Bailey Road 28972 1 Butte Road 12310 San Mateo Road 01 Dixon Landing Road 9999"$. Austin Road Pittsburg, CA 94565 COnrall'rR 97330 Halt Moon Bay, CA 94019 Milpitas, CA 95035 Manteca, CA 95336 Phone (925)458-9800 Phone (541)745-2018 Phone (650) 726-1819 Phone (408) 945-2800 Phone(209) 982-4298 Fax(925)458-9891 Fax(541) 745-3826 Fax(650)726-9183 Fax(408) 262-2871 Fax (209)982-1009 NON-HAZARDOUS WASTE MANIFEST GENERATOR WASTE ACCEPTANCE NO. M 1LING ADQ ESS 20500 g pallor pTi e! — r CITY, STATE, ZIP REQUIRED PERSONAL`PROTECTIVE EQUIPMENT C 9 PHONE Ca GLOVES ❑ GOGGLES RESPIRATOR M HARD HAT f 0 TY-VEK CKSAFETY VEST CONTACT PERSON Am On" SPECIAL HANDLING PROCEDURES: SIGNATURE OF AUTHORIZED AGENT 1 TITLE- DATE r GENERATOR'S CERTIFICATION:I hereby certify chat the above named material is not a hazAous - waste as defined by 40 CFR Para 261 or title 22 of the Caliiomia code of regulations,has been properly described,classified and packaged,and Is in proper condition for transportation according to applicable regulations;AND,if the waste Is a treatment residue of a previously restricted hazardous waste J subject to the Land Disposal Restrictions,1 certify and warrant that the waste has been treated in accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as definad by RECEIVING FACILITY fff 40 CFR Part 261. 3 WASTE TYPE: ❑DISPOSAL ❑SLUDGE F ❑CONSTRUCTION ❑WOOD ❑DEBRIS L ' Cl OTHER ❑SPEfi9AL WASTE GENERATING FACILITY 205 NOU61 Holly DTTve TRACY TRANSPORTER NOTES: VEHICLE LICENSE NUMBER[� _ TR CK NUMBER ADDRESS " CITY, STATE, ZIP I LQdLCA 25241 i PHONE END GUMP BOTTOM DUMP TRANSFER ❑ ❑ SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS , ❑ D © O 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. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) I: DISPOSE OTHER REMARKS ❑ SOIL Q CONSTRUCTION . FACILITY ICKET NUMBER DEBRIS f ❑ NON-FRIABLE ASB STOS" s SIGNAT RE F AUTHOnIZED AGE T DAT O WO i) A�j - U.SP CIAL 8THER s SCHEDULING MUST BE MAD16P,j11rOR TO 3:00 P:M,TME DAY PRIOR TQ EXPECTED ARRIVAL.ANY UNSCHEDULED LOADS ARE SUBJECY' 'TO REFUSAL UPON A!ARIVA .ONGOING DAILY DELIVERIES IVt'IUST 13E SCHEDULED WITH THE LANDFILL THE DAY BEFORE. z If'• Ftev i 1�0s NS-024 GENERATOR: MANIFEST# .'. ,,; ;