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t....l 1�l�IICr LCtl11�tV11 LJ VA BYIVYnaAne U ervrrvy eaeeaeeae L._1 s ve.rwe.. <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road- 12 an Mateo Road 1601 Dixon La Road 9999 S.Austin Road <br /> Pittsburg,CA 94565 Half on Bay,CA 94019 Milpitas,CA 95 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS -3406 <br /> PC) 8QX 7111 <br /> CITY,-STATE, REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> P <br /> TX4622 i 07 4 4 O GLOVES O GOGGLES O RESPIRATOR O HARD HAT <br /> O TY VEK O OTHER <br /> ON SPECIAL HANDLING PROCEDURES: <br /> SIINW/WM7 DATE <br /> AA� <br /> f. <br /> GENERATOR'S CERTIFICAMN:I hereby certify that the above na ateriai is not a hazardous <br /> waste as defined by 40 CFR Part 281 or tide 22 of the Caidomia code oVegutatians,has been properly <br /> classified and packaged,and is in proper condition for transportation axording to applicable <br /> regulations; AND,If the waste Is a treatment residue of a prevkwaly restricted hazardous wast <br /> subject to the LAW Disposal Restrictions,I certify and warrant that the waste has been tread In RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 288 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 281. <br /> WASTE TYPE: <br /> O DISPOSAL O SLUDGE <br /> O CONSTRUCTION O WOOD <br /> O DEBRIS O OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> 7 ELEVEN#32262 2360 GRANTLINE RD TRACY CA . <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> AD S <br /> CITY, ,ZIP <br /> P H N GA 015029 ENQ DMP BOTTOM DUMP TRANSFER <br /> SK UTHORIZED AGENT OR DRIVER DATE ROLL FF S FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been 18 YARDS <br /> accepted and to the best of my knowledge the aforegoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate. , <br /> p ? DISPOSE OTHER <br /> ` O <br /> REMARKS SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> f r ASBESTOS A <br /> SICNJ TORE OF AUTHORIZED AGENT DATE <br /> t i O WOOD <br /> O ASH <br /> j '• O SPECIAL OTHER <br /> HEDULING MUST BE MADE PRIORTO 3:00 P. .THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT_ <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE:. <br /> TRANSPORTER COPY MANIFEST#G <br />