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<br /> CITY, STATE,ZI = ..4 REQUIR PERSONAL PROTECTIVE EQUIPMENT-- `
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<br /> UGLOVES a GOGGLES Q RESPIRATOR '❑HARD HAT
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<br /> CONTACT,PER:SON SPECIAL HANDLING PROCEDURES -
<br /> SIGNATURE OF AUTHORIZED AGENT f TITLE DATE /
<br /> GENERATOR S CEFMFICATION I hereby certify that the above named material Is not a hazardous
<br /> waste as defined by 40 CFft Part 261 or title 22 of the CaNfomia code of regulations hes been properly
<br /> described dassllied and packaged and is In proper condtlaon for transportation afxording to applicable
<br /> regulations ARM It the waste Is a fxestment residua of a prevlowly restricted hazardous waste
<br /> aublact to We Land Disposal Restncteons-o certity and warrant that the waste has been treated in RECEIVING FACILITY
<br /> accordance with the requirements of 40 CFR Pert 266 and is no longer a hazardous waste as defined by
<br /> 40 CFR Pert 261
<br /> WASTE TYPE -•~-�- .. _._.
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<br /> E]CONSTRUCTION ❑WOOD y `
<br /> la DEBRIS ] ER v
<br /> O SPECIAL WASTE
<br /> NERATIINN�G FACILITY
<br /> TRANSPORTER , NOTES VEHICLE LICENSE NUMBER TRUCK[NUMBER
<br /> ADDRESS J 5 P s -
<br /> CITY,STATE,ZIP
<br /> PHONE END DUMP BOTTOM DUMP TRANS
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<br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS
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<br /> " 5CUBIC 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
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