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5 gp� �;y,rt •yam•. .a t x, r'^'`""'.(^y'"�a x 5___—_ __ --. t •— <br /> , � 4� .. -v'rt`�!+ ""d,$� ��� .f •.:arri�`���v " int w <br /> w <br /> w , II Oa �� f .,;Mph r=F r014i asManc <br /> s�anF 15S r Yr-+- eY' f Lai .. <br /> jl Ldfill "�� `,` Sanitary ndfill` - Sanitalry Laf>rd '11 " -°L"an it <br /> y - '901 Belle rRoacl „ _ `12310 San Mateo Road 16014D ion`LAnding Road 9999 S Austin Road <br /> U, ftiburg,CA 94565 Half Moon 6ay,`CA`94019 Milpitas;CA 95035 - Manteca,CA 95336 <br /> -Phone (925)458-9800 Phone (650)726,1879_ ,,,,,,Phone(408) 945-2800 Phone(209)982-4298 <br /> Fax(925) 458-9891 Fax (650)726-9183 Fax (408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR a <br /> —'" WASTE ACCEPTANCE NO. <br /> MAILING ADDRES 1 <br /> CITY, STATE,ZIP i 7 17 REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE ❑GLOVES ❑GOGGLES ❑'RESPIRATOR 0 HARD HAT <br /> U TY VEK 0 OTHER <br /> CONTACT PERSON I <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> * -S <br /> GENERATOR S CERTlFICAT)ON 1 hereby certrty that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or trite 22 o1 the Caldomra code of regulations has been properly <br /> described classified and packaged and is in proper condition for transportation a-=ding to applicable <br /> regulations AND,It 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 been treated sn RECEIVI NG F CILITY <br /> aCCGrdanCe with the requirements of 40 CFR Part 268 and is no ionger a hazardous waste as defined by may,,, <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> DDISPOSAL ❑SLUDGE <br /> O CONSTRUCTION ❑WOOD <br /> I-UDEBR <br /> IS ;� .OTHER <br /> ❑SPECIAL WASTE r •�� <br /> GENERATING FACILIITfY <br /> ZTRANtSPOFRITER // NOTES VEHICLE LICENSE NUMBER TRUCK'NUMBER <br /> fT- - <br /> DDRESS <br /> CITY, STATE,ZIP C1 <br /> t � <br /> PHONE END DUMP BOTTOM DUMP TRAN,5FIER <br /> iilil�SIGNATURE OF THORIZED R DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> h'/ <br /> "'k/ <br /> CUBIC YARDS <br /> 1 hereby certify that thwtabove named material has been - <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD (TO BE COMpI=ETED,ev LANDFILL) <br /> Is true and accurate F - <br /> DISPOSE OTHER <br /> REMARKS ❑ SOIL <br /> _ 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER - DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORI ED AGENT DATE <br /> ❑WOOD <br /> O ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE P R •OD P.M.THE DAY PRIORTO EXPECTED ARRIVA t UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST Be SCHEDULE H THE LANDFILL THE DAY"BEP RE <br /> ' as A►LIM PO .a � A 0 *07 <br />