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^ <br /> � <br /> §: r <br /> y �r <br /> mil <br /> n�„�y` ■, +yj S s r 4 1Mr T77 <br /> _ten xwx <br /> . 1• N ;�'fsanY" <br /> ��� �t � -�����_�;��, r �►� s anc�#III f _�`'� �`�Laridflll`y <br /> '� rF N k wy <br /> Q 113 f1 y Road �i a'�f" r f 2310 San°�VI„ d� ��AI'�/ $ �:�n - <br /> ateo'Roa M <br /> Y Plttsb uCA'94b65, A ' ' F »` 1 I ' xohl` ndinj Road 9999 S Austin Roa <br /> 9. Piko;Moon B4,FCA 94019 A Mf$ftas, CA 966035 Manteca, 5336 <br /> Phone (925)458-9800 PhonC)t"9 <br /> e'(660) 726-1$19 Phone(408)945-2800 Phone(209)-9 <br /> Fax,(925)458-9891 Fax(650) 726-9183 - Fax(408)262-2871 <br /> "Fax(209 082- <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR `1_,. <br /> G WASTE ACCEPTANCE NO. <br /> MAILING ADDR SS f <br /> CITY, STATE, ZIP <br /> REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 61 / <br /> PHONE ❑CLOVES 0 GOGGLES C]RESPIRATOR 0 HARD HA <br /> CONTACT PERSON ❑TY VEK 0 OTHER <br /> r I SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE 'DATE <br /> GENERATORS CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Pari 261 or hue 22 of the Catitomta code of regufabons has been Property <br /> described claBstried and packaged and u in Proper Condition for transportation a^cordlnp to aPPhcable <br /> regulations AND tt the waste Is s troetmant maldus of a Prwiousy restricted hazardow waste <br /> subject to the Land Disposal Restrictions I ca and warrant <br /> accordance with the requ rements of 40 CFR Part 268 and is no t the waste has peen treated In RECEIVING FACILITY <br /> 40 CFR Part 251 onger a hazardous waste as defined by <br /> WASTE TYPE .. <br /> O DISPOSAL 0 SLUDGE ~ <br /> U CONSTRUCTION ❑WOOD <br /> 0 DEBRIS THER <br /> C]SPECIAL WASTE <br /> GENERATING FACILITY _ <br /> a r <br /> TRANSPORTE NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> - ADDRESS <br /> CITY, STATE,ZIP - ` #> <br /> L <br /> -- PHONE - <br /> _ END DUMP == BOTTOM DUMP <br /> SIGNATURE OFAUTHORIZE r- ENT OT DRIVER DATE ❑ ❑ <br /> ROLL-0FF S FLAT BEIJ VAN DRUMS <br /> ILI <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 i <br /> Is true and accurate. DISPOSAL METHOD (TO BE COMPLETED 8 LANDFILL) <br /> y <br /> DISPOSE OTHER <br /> EMARKS ❑ SOIL <br /> ❑ conlsrRucTloN <br /> FACILITY TICKI`7 NUMB DEBRIS <br /> ❑ NON-FRIABLE <br /> SIGNATUR OFA HORIZE AGENT DATE ASBESTOS <br /> \ 0 WOOD <br /> C]ASH <br /> �s ❑SPECIAL OTHER f � <br /> SCHEDULING MUST BE MAqE PRI00763 04 RM.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UU86HEDULED LOADS ARE SUI�Et:T <br /> TO REFUSAL UPON ARRIVAE70NGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE t)AY BEFORE <br /> r <br /> - • st.r 4 w Aw <br />