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k ¢ t a <br /> wg <br /> 'S (( an�.lf�i'� s#' ? t�}TF <br /> Y f Fry y , w f a yandfili San nary kLand#ix y r a tfii <br /> r frit S y m'KY i 'y�P ; fL RY'&L r'P bks SuYT d b l^,` 1 n J5 <br /> 1 alley Road - ;,*d- 12 1San Ma o' load 164 Dixon Landing Road x9,99 S'At�sttn Rgad <br /> Pfttsdr�;CA94565 -+ Haff�Moon>Eay�;CA'94019 ` Milpltis;CA'95�}35 ";$"d �Mantec ;;Ga°95336 <br /> NPh§yk925},458-9800 f'hone`(fi50) 726-18{9 Phone(408)945-2800 Phone(209)-982=4298 <br /> Fax'{925)456-9891`' Fez(650)726-9183 ' Fax (408)`262-2871 Fax{209)982-1.009 <br /> /ti < Y"F t' r - <br /> NDN-HAZARDOUS WASTE MANIFEST x H sr <br /> GENERATORW T E N Y <br /> � WASTE ACCEPTANCE O. <br /> MAILING ADDRESS AJ , <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE ❑GLOVES a GOGGLES a RESPIRATOFI, ❑HARD HAT <br /> CONTACT PERSON <br /> ❑TY-VEK ❑OTHER <br /> ��J <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material Is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the Caldomut code of regulations has been property <br /> described classdied and packaged and is in proper condition for transportation a-cording to applcabie <br /> ragulabons AND,If the waste is a treatment residue at a previously restricted hazardous wute <br /> subject to the Land Disposal Restrictions I certify and warrant that the waste has been treated in <br /> e RECEIVING FACILITY <br /> accordance wrlh the requirements of 40 CFR Part 268 and is no Longer a hazardous waste as defined <br /> 40 CFR Pa261 <br /> MERWASTE TYPE <br /> Q DISPOSAL U SLUDGE <br /> ❑CONSTRUCTION 0 WOOD <br /> O DEBRIS OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> RANSP0RTER NOTES VEHICLE LICENSE UMBER TRUCK NUMBER <br /> ADDRESS �-+ 1 S t <br /> CITY, STATE,ZIP <br /> PHONE aEND DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGEN R DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <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 DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate, <br /> DISPOSE OTHER <br /> EMARKS U SOIL <br /> ❑ CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT ATE ASBESTOS <br /> O WOOD <br /> r U ASH <br /> U SPECIAL OTHER <br /> HIULINGtMU " <br /> ST BE MADE PRlORTO 300 P.M THE DAY PRIORTO EXPECTED ARRIVAL�ANY UNSGHEDULED LOADS ARE SUBJECT <br /> O <br /> REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL`THE'DAY BEFORE. <br />