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J Tiz�{l�v—� � "� a�' "�Sf�''�ny'z<�Cr, a�s'�'r sy.ws ar"Sa4 ,., xx •-rte-" <br /> `¢�� ,� +• � ""79 's1�1'Y 3 'r- It' '�" yz1_ F`S'°aeY learc..t i Ji' " ,A �„ y <br /> ,� �1' <br /> �?w 1i1* 4 gwk4 <br /> Ito � 11 <br /> 7r <br /> z 4 sir �r r nu' E to s ik 3 w, o- rr sT• <br /> andfili <br /> Qy <br /> >Bailef oad ��4 ,`, s � 9 310° �l�oad'�� r �.r rte„ � oA,� <br /> eo Bi3)TD xltsrp - r) <br /> Pitts�urg,'C�4 94565 M. If Ma(a ," AvJ4019 _ r„ , dmg Road 9899 S Austin Road <br /> Phone(925)458;98017 Phony 6 726=1819- M11P has' 19503S i- Mantec8,GA 95336` <br /> ( Ftiond{4 94x2$00 <br /> Fax`(925)'45$-9891`> Fa)(650)728-9163' Fax'{ 08) 26't <br /> 2871" P�ione(209)982-42 <br /> Fic(209)982=i <br /> 4t NON-HAZARDOUS WASTE MANIFET <br /> GENERATOR t J <br /> WASTE ACCEPTANCE NO. <br /> Y � - <br /> MAILING ADDRESS , <br /> CITY, STATE, ZIP � ' � w <br /> REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE C ❑GLOVES U GOGGLES f 0 RESPIRATOR U HARD HAT <br /> CONTACT PERSON 2 <br /> ❑TY-VEK 0 OTHER <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT I TITLE DATE <br /> Soja <br /> s� <br /> GENERATOR S CERTIFICATION I hereby pe'riq that the above named maianaf is not a hazardous <br /> waste a$defined by 40 CFR Part 261 or tree 22 dlthe C,Ilom,a code of reguiations has been property <br /> described clasartied and Packaged and is in Proper condition for transportafion a�cordmg to applicable <br /> regulatrorm AND,If the waats Is a troepnent residue of a prnvtouety restricted ha"rdous waste <br /> lulled 10 the Land Dreposai Reslnchons I certify and wanam that the waste has been treated in <br /> accordanoe 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 /> U DISPOSAL ❑SLUDGE <br /> U CONSTRUCTION 0 WOOD <br /> U DEBRIS .rTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTERI - b NOTES VEHICLE LICENSE N MBER TRUCK NUMBER <br /> ADDRESS _ <br /> r <br /> CI7_ 'STATE,-ZIP= <br /> PHONE� <br /> END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE AUTHORIZ AGEN R DRIVER DATE - <br /> ROLL-L-OFF 5 FLAT BED VAN DRUMS <br /> * L ❑ ❑ ❑ ❑ t <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 /> is true and accurate DISPOSAL METHOD (TO BE COMPLETED By LANDFILL) <br /> w <br /> DISPOSE OTHER <br /> EMARKS ' 0 SOIL <br /> r <br /> FACILITY TICKET NUMBER 0 CONSTRUCTION <br /> j DEBRIS <br /> U NON-FRIABLE <br /> SIGNATURE OF AUT ORIZ AGENT) DATE ASBESTOS <br /> ❑WOO_D <br /> 0 ASH <br /> e 0 SPECIAL <br /> _ OTHER t <br /> Y I <br /> SCHEDULING MUST BE MADE 10 '-t6O0 00 P M.THi;DAY PRIORTO E ECTED ARRIVAL a ANY UNSCHt6ULED LOADS ARE SOBjEC T <br /> TO REFUSAL UPON ARRIVA GOING,DAILY DELIVERIES MUST E SCHEDULED WITH THE LANDFILL THE OW BEF <br /> ORI;, <br /> MANIFEST N <br /> - - _ CI <br />