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• �. .,��ry�,t, I Corrin tsutte LjOx M6untalri 0 Newby Island Forward ry` <br /> Sam#ary LandfillLand ' <br /> Sanl#ary Landfall. 'anitary Landfill Landfill <br /> 901 Bailey,Road <br /> " 28972 Buie.Road 12310.San Mateo„Roatl 01 Dixon Landing Road 9999 S.Austin Road <br /> Piisburgr CA 94565 Corvallis,.OR 97330 Haff:Moon Ba ; GA 94019 Milpitas, CA 95035i. <br /> Phone (925)458-9800 on06 <br /> Phone(54i)745 2018 Phe.(650) 26-1819 Phone (408)945-2800 honee(2 9) 982-4298 <br /> Fax(925) 458-9891 Fax (541) 745-3826 Fax(650) 726-9183 Fax (408)2624871 Fax (209) 982-1009 <br /> NONHAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> WASTE ACCEPTANC€ NO. <br /> M iLING.ADD ESS. <br /> 205 L&m*Holly Dfive <br /> 91905 <br /> CITY, STATE, ZiP. 1` REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> r <br /> PHONE. " XGLOVES ❑ GOGGLES - ❑ RESPIRATOR JJ HARD HAT <br /> U TY-VEK Q[SAFETY VEST " <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES; I <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DgTE <br /> GENERATOR'S CERT'IF'ICATION;I hereby certify that the abo6e namad material Is riot s haiardous <br /> waste as defined by 44 CFR Part 261 or tl'tle 22 of the California code of regulations has beeri`p79us: <br /> described,classified anrS packaged,and is In proper condition for transportatiori according!o:applicable _ <br /> regulations;AND,Ifrooedy <br /> he <br /> waste Is a and <br /> residue of a previously restricted hazardous waste <br /> Subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requlrements of 40 CFR Part 266 and Is,no longer a hazardous waste as_d fined by':; <br /> 40 CFR ParY261 <br /> :WASTE TYPE. <br /> ISP:OSAL 13 SLUDGE, <br /> LJ CONSTRUCTION O WOOD <br /> u DEBRIS'. ' d OTHER <br /> LIS PECIAL.WASTE <br /> GENERATING FACILITY <br /> 060 E�mgy Dive <br /> TRACY <br /> TRANSPORTER _'- ' NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRES 'Ail x6c_ <br /> d la .—" <br /> r <br /> E <br /> TATE ZIP7 . <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> U ❑ ❑ 0 <br /> CUBIC YARDS <br /> ! hereby certify that the abar►e named mate <br /> ria# has been <br /> accepted.and to the best of my knowledge the foregoing <br /> DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate . <br /> I DISPOSE OTHER <br /> REMARKS t7'SOIL <br /> b`CONSTRUCTION <br /> DEBRIS <br /> R` FACILITY` ICKET NL1 _BE D. NON-f=RIAB <br /> E 5BE TOS <br /> .'ti SIGNAT RE OF AUT F�ZED A ENT " D rt. <br /> u'fi r a Op <br /> < 1 <br /> � <br /> L <br /> G 5 ECI L O HER <br /> NEW <br /> k > Dl1ILING MUST BE MADE BRIO 3:00 R M THE bAY PRO O EXPECTED ARRIVAL•ANY UNSC1iEDULED LOADS ARE SUBJECT <br /> A t0 <br /> E�USAL UPON ARRIVAL O OIN®DAILY DELIViiIES'MUST'BE SCHEDULED WITH TNtLANDFILL THE DAY BEFORE. <br /> i <br /> 'i IjV21J09 NS <br /> 024 O # 44,11`1 ON <br /> G NERAT R CO MANIFEs <br /> ..4rS7,va1��:a�, <br />