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Sanitary Landfill Landfill - u%JA FWOUniain Li rvsrwDy 151ai'iu r-orwara <br /> Sanitary LandfillSanitary Landfill Landfill <br /> 901 Bailey Road 28972 N <br /> Pittsburg, CA 94565 i Butte'Road 12310 San Mateo'Road 01 Dixon Landing Road 9999 S. Austin Road <br /> Corvallis, R 97,330 Half Moon Say, CA 94019 Milpitas, CA 95035 Manteca, CA 95336 <br /> Phone (925)458-9800 Phone (541)745-2018 Phone(650) 726-18 4.9 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 <br /> M MNG ADD ESS <br /> WASTE ACCEPTANCE NO. <br /> .. �y <br /> 20500 S+ .H 1�ve 9905 <br /> CITY, STATE, ZIP. REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHOKE q (X•GLOVES 0 GOGGLES ❑ RESPIRATOR X1 HARD HAT <br /> C N ACT.PERSON Q'TY-VEK CXSAFETY VEST <br /> E <br /> SPECIAL HANDLING.PROCEDURES: y <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERAT6A'S'0ERTIFlCAT10N:I hereby cerllfy that the above named material is not a hazartlaus <br /> waste as defined by 40 CER Part 261 or title 22 of the Catlfomia code of regulations,has been 0operly <br /> desdribed,classified and packaged,and is In proper condition for transportation according to applicable <br /> regulations;AND;:if the waste is a treatment residue of a previously restricted hazardous waste <br /> subject to the land Disposal Restrictions,I certify and warrant that the waste has boon treated in- <br /> accordance with the requiremenis of 40 CFR Part 260 and is no longer a hazardous waste as defined by RECEIVING FACILITY <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> —WIMPOSAL O SLUDGE <br /> Q CONSTRUCTION D WOOD <br /> U DEBRIS ©OTHER <br /> Cl SPECIAL WASTE <br /> GENERATING-FACILITY <br /> SOA <br /> it <br /> TRANSPORTER . '` NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER i <br /> . I <br /> ADDRESS 17 ` <br /> CITY, STATE, ZIP <br /> f <br /> LedLC.A 95241 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SLJ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> © © ❑ ❑ <br /> II <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 /> i8 true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) s <br /> DISPOSE OTHER <br /> REMARKS 0 SOIL <br /> r O CONSTRUCTION <br /> FACILITY TICKET NUMBER <br /> DEBRIS ,. <br /> O NON-FRIABLE f <br /> SIGNATURE. � AUTHOR IZEP-AENT ,• D' TE. A 8EST07 <br /> v E7 COD <br /> f err ASH <br /> SPECIAL OTHER <br /> SCHEDULING MUST BE IIIARE`PRIOR TO 3:00 P.M,THE DAY PRIOR,TO EXPECTED ARRIVAL.ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON J(1311 VAL.ONf3011VG.DAILY DELIVM <br /> ERIES US"Ir BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. l <br /> Rev 11/09 NS-024 <br /> GENERATOR COPY MANIFEST# U <br />