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v 't�' �'-* 3r aTy;r 'waA 7� rr`t a� <br /> � AI�P+ 1X1 a,i a'N'ri�r res rir (W �� I lap ter r <br /> c S Cyt, „ r z "t " w <br /> an �.�n fill , . 9 - -;S n fXv <br /> dfilk, rYl-ancifill °��'� F f IIS <br /> SBANAxmt-0 SRoadifi01 Dixon Landin <' "". &Road 9999 S Austin Road <br /> '' a'Pltt$tiurg;#CA 9458 f��a _ 94019 °y Mfl6ltas;CA 95035` 9' ` <br /> P x '' r �Ilanteca, CA 95338` <br /> Phone(925)458-9800 Phoir (650)728-1819 ^ " Phone (408)945-2800 Phone(209J'982-429 <br /> Fax(925)458-9891 Fa)-(650)726-9183 Faz(408) 2fi2-2871 Fax(209) 982-10 <br /> NON-HAZARDOR WASTE MANIFEST <br /> GENERATOR w WASTE ACCEPTANCE NO. <br /> 7' t' `f` 11 <br /> MAILING ADDRESS - 4 r�rT f <br /> CITY, STATE,ZIP .., E REQUIRED PERSONAL. PROTECTIVE EQUIPMENT <br /> PHONE Q GLOVES Q GOGGLES ❑RESPIRATOW Q HARD HAT( <br /> 1 <br /> ❑TY-VEK Q OTHER ` <br /> CONTACT PERSON -� <br /> , -_ SPECIAL HANDLING PROCEDURES <br /> r <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE PATE <br /> GENERATOR S CERTIFICATION I hereby certify that the above named matenal is not a hazard <br /> waste as defined by 40 CFR Part 261 or title 22 of the California cads of regulaGona has been p rly <br /> described classified and packaged and is in proper cond�aon for transportation a^cordmg to appl <br /> regulations AND,If the waste Is a treatment residue of a Prwbusfy reatNclsd hazardous wads <br /> subject 10 the accordance w�Ih requirements <br /> eDismentsrof 44o1CFq art 2668 nd end nolothat longer waste has been waste Ftj In RECEIVING FACILITY r <br /> 40 GFR Part 261r a hazardous waste ss defined by <br /> WASTE TYPE <br /> ❑DISPOSAL Q SLUDGE <br /> U CONSTRUCTION WOOD , <br /> U DEBRIS .�R <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> r r <br /> 14 4 <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK'NUMBER <br /> ADDRESS <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM 01 MP IRAN R <br /> SIGNATURE OF AUTHORIZED A ENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I hereby certify that the above named material has <br /> be <br /> accepted and to the best of my knowledge the foreIs true and accurate. (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> EMARKS <br /> 5 <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT TE WOOD os <br /> - 0 WOOD <br /> Q ASH <br /> a ❑SPECIAL OTFIER <br /> r CHEDUUNG MUST BE MADE PRIORTO 3:60 PM THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED" O6 -AIRIE'S- i JE <br /> TO REFUSAL UPON ARRIVAL ONGOING-DAILYIDELIVERIESMUST BE SCHEDULED WITH'THE LANDFILL Ti1E DAYBEFORE <br /> r v � INANiFEST k <br />