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0-2a <br /> 4 rr a<�...1'� vsY' - �" -Zl .i-dr' "' „'t- , , b Isiand `1Celler' yolI ., Y❑ Qxi�+ountln } � ±!► Y° <br /> Y r �'niel - F v $r e .f3 { ! s- dflll <br /> " ,`§WtaMUnd�li „ �ft -, Latidf�ll Sanf aly;Landfill <br /> 123* an Mateo Road 1601 Duron Landing Road 9999 S'Austln Road <br /> A-Pittsburg,CA 94565 Half �n Bay,CA 94019 Mllpft4,CA 85035 - Manteca, CA 95336 <br /> $ Phone (925) 458-9800 Phon (650) 726-1819 Phone�Q8) 945-2800 Phone(209)982-4298 <br /> Fax(925) 458-9891 Fax (650)726-9183 Fax(4[x262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> kGENER"_ i WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS r„ <br /> �TAEOUIPNIENT Iz-A <br /> CITY, STATE, ZIP S REQUIRED PERSONAL P <br /> ©GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> EMILPHONE <br /> ❑TY-VEK U OTHER <br /> CONTACT PERSONr 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 Pori 261 or title 22 of the California sada of regulatwns has been property <br /> described clasadied and packaged and is,n proper coriddion for transpodabon a-cording to applicable <br /> regulabons„AND,if the waste is a treatment residue of a prsrlousty rewictod hazardous waste t <br />' subtect kg the Land Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordepce with the regwrementg at 40 CFR Part 268 and rs no longer a�razardous waste as defined by y <br /> e CFR Part 281 L <br /> WASTE TYPE <br /> O DISPOSAL ID SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS �„ER <br /> ❑SPECIAL WASTE rF <br /> GENERATING FACILITY <br /> "WWi�6ffC1<11 � <br /> TRANSPORTED NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> 1 CITY,STATE, ZIP t ' <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> SIGNSF AUTHORIZED NT=DRIVER DRIVER DATE ROLL-OFF(S) 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 /> ❑ SOIL <br /> EMARKS -�a <br /> * , ❑CONSTRUCTION <br /> ' <br /> FACILITY TICKET NUMBER F DEBRIS�NON-)=RIABLE <br /> ASBESTOS <br /> SIGNATOR OF AUT ZED*GW PATE <br /> O WOOD <br /> { <br /> � <br /> ❑ASH <br /> 7/- <br /> TA <br /> ECTAL OTFIER <br /> r aw <br /> Mill 1111611111111"Eirm <br /> r SCH>EDULiNG MUST BE MADE PRIOR-rdI 0 P M.THE DAY PRIORTO EXP E= D ARRIVAL•ANY UNSCHEDULED LADS TARE SUBJECT <br /> TOs REIFUSAL UPON;ARRIVAL.4lGQIWGAILY,DELIVERIES,'MUST BE SCHEDULED WITH THE�L�►NII�FiLLTNIIYrEaE- <br />