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�� w,,+�.i w�a ,y�""Y�x�: Y; w•r3*• <br /> a 4� z, �i3 §�R�� �=��+ +� !` '`v� Y"v" i i5 �� �Y�t r �Y� FnM § w- <br /> ­10141 <br /> a * i4 r'f IIEr-C �' q ap ,a-.x d "+� 'k ��, ,'_,� .r =+� li' '` v; Z <br /> q%yon"O ��Ox iVlountal �° _+� 3� � <br /> I "ate Baa f] N 1 <br /> �p rm < r,y, �4 , mss N� Is d <br /> _ <br /> t, ;�,`ganitalyL ndf �l x; °���Srl�#a Lan flil`y t " � µ E rwctl- <br /> r ; f .ry` d �- Sanitary Landfill �`_ ` , � <br /> an ill <br /> 9,1 11 ey Road j4a ` xA12310 San Mateo Road 1 d--V Ian Landing Road $999 S`-Austfn Road <br /> Pittsburg,CA 94565'1 Half Moon Bay,,CA 94019 Milpitas,CA 95035 Manteca`, <br /> Phone (925) 458-9800 Phone(650)726.1819 Phone(408)945-2800 O) 95336 <br /> 2-4 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax 408 262-2871 Phone 9)9 982-42� <br /> ( } +_ Fax(209}982-1 <br /> NON-HAZARDOUS WASTE MANIFEST ' <br /> GENERATORO <br /> WASTE ACCEPTANCE <br /> MAILING ADDRESS <br /> CITY, STATE, ZIP_ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 9 <br /> PHONE U GLOVES U GOGGLES O hESPIRATOR U HARD HAT <br /> CONTACT PERSON <br /> ❑TY VEK U OTHER �. <br /> _ , <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> �q <br /> GENERATOR S CERTIFICATION I hereby certify that the above named matenal is not a hazardous <br /> waste as defined by 40 CFR Part 261 or Ltle 22 of the Cahfomia code of regutatione has been property <br /> described classified and packaged and is in proper cowtt*n for transportation a cording to applicable <br /> re9utations AND,If the wes%Is a trsetment residue of a previously rostrfctad Iia *us waste <br /> suliect to the Land Lhspcoal Restnctwns I certify and warrant that the waste has been treated in <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by RECEIVING FACILITY <br /> 40 CFR Part 261 =, <br /> WASTE TYPE <br /> Q DISPOSAL U SLUDGE " <br /> U CONST UCT10 U WOOD <br /> U DEBRIS HER <br /> U SPECIA VJA§T <br /> GENERATI G CILITY - <br /> Al <br /> TRANSPORTER21;11111111 - NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESSA . <br /> jC <br /> CITY;STATE;ZIP= <br /> PHONE.__ Lot <br /> - - - - END DUMP BO MP TRANSFER <br /> SIGNATURE AUTHORI A NO <br /> T R RO <br /> DRIVER DATE ❑ - - -_ __ ❑T f - - U <br /> LL-OFF S A� FtAT-BED VAN D MS <br /> ❑ <br /> v <br /> 0 ❑ ❑ ❑ <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 /> 7�AN�FT Is true and accurate. DISPOSAL METHOD (TO BE EDDISPO4 <br /> EMARKS U SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBE DEBRIS <br /> U NON-FRIABLE <br /> SIGNATURE OF A IZED AG TDATE ASBESTOS <br /> U WOOD 'h <br /> w` U ASH <br /> f ❑SPECIAL OTHER; F t-•'; <br /> SCHEDULING MUST BE MADE PRIORTO 3.00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED 0pRE WB,,IE <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILLFTHE,DAY'!BEEQRE <br /> MANIFEST#i� r" �F 8 6 <br />