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ti °,Sawn fr.sY µ,y.V1at44 r riSan��,tal`��YcrliiM1l:l`, gyL"rys' �nEdao'r 4aaf <br /> aM <br /> SanitaryLandfll Lan <br /> 904BafyPoh�t � 3l0Sa ' f oRd 160'1Dixon'LandingiRoad 9999 S Austin <br /> u <br /> st•ri <br /> `naUR'`o«`a <br /> 'dP1466Urg,-6X94585vr <br /> .`c <br /> Half Moon Bay;CN 4019 Milpitas,CA'95035 Manteca,CA 95336 <br /> Phon6`(925)458-9800 ,' Phone(650)726-1819 -Phone(408)945-2800 Phone(209)982-4298' <br /> Fax(925)458-9811 Fax(650)726-9183 Fax(408)262-2871 Fax(209) 982-10 <br /> ` NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR C- WASTE ACCEPTANCE NO. <br /> MAKING ADDRESSL C; �� <br /> 13[1 <br /> CITY, STATE,ZIP c i REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE Q GLOVES Q GOGGLES ❑RESPIRAT09 D HARD HAT <br /> ❑TY VEK Q OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR S CERTIFiCATt4N I hereby certify that the above named material is not a hazardous <br /> waste as deNnad by 40 CFR Part 26 1 or title 22 of the California code of regulations has been properly <br /> described ctassfied and packaged and is in proper condition for transportation a^cordmg to applicable <br /> regulations AND,if the waste is a treatment residue of a previcuefy restricted hazardous waste <br /> "act to the Land Disposal Restrictions f certlty and warrant that the waste has been treated In RECEIVING <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined FACILITY by i <br /> 40 CFR Part 281 <br /> WASTE TYPE <br /> d DISPOSALS 0 SLUDGE <br /> U CONSTRUCTION ❑WOOD <br /> ❑DEBRIS I "` bTHER <br /> ❑SPECIAL�V,AST <br /> �aENERATING'FACILITY <br /> e/t L < ' <br /> TRANSPORTER y� G NOTESVEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS Q ! <br /> END DUMP BOTTOM DUMP�T TRANS ER.—t <br /> r <br /> SIGNATURE;OFAUTH RiZED WE DRIVER DATE ROLL-OFF S—T FLAT-BED VAN 1DRUMS l -z <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 accurate41 <br /> , <br /> DISPOSE OTHER <br /> REMARK S ❑ SOIL ' <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE t , <br /> SIGNATURE OFAUTHORIZED ENT DATE ASBESTOS <br /> ❑WOOD <br /> 0 ASH <br /> w <br /> rk ❑SPECIAL OTHER <br /> SCED UNG MU1 T bE MADE PRIORTO 3.00 PM THE DAY PRI RT EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SU13JECT <br /> REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIE MUST SE,SCHEDULED WITH THE LANDFILIL` THE DAY BEFORE , <br /> MANIFEST#k — 4369 �, <br />