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t � 4 f � t r ," C� Ari r {{r� - <br /> Ck ° '4 'F� µr * t . ..1 r' !`�'�..d , Newby1' � d�a"Y ';tC". y °�' a� <br /> fSg t 'xr17, tlfilf� � �'��'�Sai� � ° �`r � ,,Q , � ��,.. ,s,an -x , Forward ° x <br /> -Te�, n Landfill ' <br /> " '.90t.8aiie" Roa F` '4t �a 1 3 QSan- ��eo��d T''r`'-' }!- i66)�Daryl_andin'-Fioad�� Laridfill - <br /> '�Plttsburg,CA 94565 Half Moon Eia'CA 94019 Milpitas,CA 95035 - `Mi9n 5 , CA Road <br /> Mani�'Ca, CA 95336 <br /> Phone(925) 458-9800 Phone(650)726.1819 Phone(408) 945-2800 Phone(209)982-4 9>' <br /> Fax(925)458-9891 Fax(650)726-9183 Fax (408) 262-2871 Fax(209) 982-1 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> - WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY, STATE, ZIP REQUIRED PERSONAL PR TEC VE EQUIPMENT <br /> PHONE ❑GLOVES O GOGGLES O RESPIRATOR 0 HARD HAT <br /> O TY VEK O OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> o � <br /> GENERATORS CERTIFICATION I hereby certrty that the above named material is nota hazardous <br /> waste an tlehned by 40 CFR Part 264 or bfla 22 of the Caldorma code of regulations bas been property <br /> described ctassl8ed and packaged and U in proper Condition for transportation a-Cording to applicable <br /> regulations AND,If the waste Is a treetrrment resldus of s prwiousy restricted haurdaus waste <br /> subleat to the Land Disposal Restrictions I certity end warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste es defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ❑DISPOSAL Q SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> •DEBRIS OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> Ila�-j <br /> TRANSPORTER [� NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> CI I Y, STATE, ZIP <br /> PHONE — END DUMP BOTTOM DUMP TRAN,9FER <br /> SIGNATURE OF AUTHORIZED ARENT OR DRIVER T DATE TROLL-0FF S� T FLAT-BED VAN Aj <br /> D UMS <br /> 7k cam' /I—L <br /> CUBIC YARDS <br /> -- <br /> I hereby certify that the above named material has been <br /> accepted and to the beat of my knowledge the foregoing <br /> Is true and accurate. DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> EMARKS w ❑SOIL <br /> } O CONSTRUCTION <br /> FACILITY TIC t=T NL)MBER w DEBRIS <br /> az ` '� ©NON-FRIABLE <br /> SIGNATURE O A Dt <br /> IZ AGENT DATE asgEST08 <br /> ❑WOOD <br /> If - I <br /> Cj n ASH <br /> 7k v , <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE�ADE PRIOR 3,00 P M THE DAY PAIORTO EXPECTED ARRIVAL+' <br /> NY UNSCHEDULED LOADS ARE SU13JECT' <br /> TO.REFUSAL UPON AIVAL. ,GOING DAILY DELIVERIES MUST BI:SCHEDy, Ep VITH THE LANDFILL,THE,DAY,BEFORE <br /> ", �r.s �tr yy�fir[ <br /> _ ' ' ' "' , ssa ' WAl1fICGQT r A*0,Q'n ' <br />