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ty,� tx 113!1$ C! ■it o � F 1'i$1''�'!r4 �� Y �� p�(�^,.. Y <br /> �� �a � ��:, � ti kYr? d -<,v uJ�4tp�� '22w}c'`ar�rr� >s z� V�u "fix `3 <br /> anitary, Lartdfll! "� ` '> y r �' Fa rc <br /> S n ar 4 nclflll z �Sanithry Landfill a= i lV <br /> 90JuSailey,RQad ` . -^, ;, ." r�2 11 ars Mate'n Rt�ad s. 1601 D�xgn Landing Aoad 999;3„S Austin Road <br /> ki4-1F W t N y,S J M& <br /> -, ,'::. t v <br /> Pittsburg,4CA 9458 't kµ ;Hall Moon Bay,-CA 94019 MiIpi#as; A$5035 x x T Manteca,CR 95336 <br /> Phone(925)458-9 00 Phone (650)728-1819 x Phone(408)945-2600 Phone(209)982-4288 <br /> Faxr'e„25) 458-9891 - F 50)726-9183 Fax(408) 262-2871 Fax(209)982-1009 <br /> Ilk IN-HAZARDS WASTE MANIFEST <br /> GENERATO a WASTE ACCEPTANC9 NQ <br /> r <br /> MAILING ADDRESS <br /> CITY, STATE, P -, REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE Y <br /> 0 GLOVES O GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> ( ❑TYVEK OOTHER <br /> CONTACT PERSON <br /> rr SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHO I ED AGENT/TITLE <br /> GENERATORS CERTIFICATION I hereby certify that the named material is not a hszardau / S <br /> waste as defined by 40 CFR Part 261 or tido 22 of the Cald code of regulations hes been property <br /> described classified and packaged and is in proper condition portation a^cording to oppircable <br /> regulations AND It the waste is a to stmsnt residue of■prtv usty restricted h---dpaf wash <br /> subject to the Land Disposal Restrictions I certify and warrant that the waste has been treatep in y RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous wasie as definedby <br /> 40 CFR Part 261 <br /> WASTE TYPE 16 <br /> ❑DISPOSAL Q SLUDGE <br /> d CONSTRUCTION ❑WOOD F <br /> 4 DEBRIS �R <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> f <br /> TRANSPORTER f ' ` NOTES VEHICLE LICENSE NUMBER TRUCK NUMB <br /> ADDRESS <br /> irf <br /> CITY, STATE, ZIP _ <br /> PHONE <br /> -END_DUMP- =_BOTTOM DUMP ,�TRAN <br /> - SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE _ ROLL-OFF S �_ - FLAT=BED- _VANT _-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 <br /> Is true and accurate. DISPOSAL METHOD (TO BEC_ D B NDFILL) <br /> _ - <br /> o solL - <br /> DISPOS OTHER <br /> REMARKS <br /> CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATU O-F A100iqRWED AG NT DATE <br /> ❑WOOD <br /> DASH . <br /> o O SPECIAL OTHER w <br /> SCHEDULING MIDST BE MADE PRIOWO 3.00 P.M THE DAY PRIORTO EXPECTED ARRMAL-ANY UNSCHEDULED LOADS ARE SUB' <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITKTHE LANDFILL THE DAY_SEFOR <br /> 4 <br /> _ <br /> - � t4 MANIFEST#� <br /> I �GENERATORCO � <br /> PY,,' sY� _ t _ ti .` ,k,a t •�;P <br />