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enitaCanyon El ox Mountain 0 Newby Island P Forward <br /> ry it f i l it <br /> 1 Bailey Road 12310 t d 1601 Dixon Landing RoadS.Austin d <br /> Pitt bur 'CA CA 565 Half y,C 019 ii ' s,CA Manteca,C 9 <br /> 5336 <br /> Pho (925) 8-98 Phone( )726-1819 e( ) 2 (2 09) X42 <br /> 98 <br /> Fax(925) 9891 Fax( )726-91 Fax( )262-2871 -.--F (2 09) -1 <br /> NON-HAZARDOUS WASTE MANIFEST l,._.r <br /> GENERATOR WASTE ACCE"ANCE NO. <br /> Tin in <br /> w ,. . <br /> MAILING ADf)FtESS � <br /> C ,STATE,ZIP REQUIRED PER L PROTECTIVE E iP <br /> MEN <br /> 0 GLOVES GOGGLES O RESPIRATOR O HARD FIAT <br /> P ONE ,,..._ <br /> k�. <br /> ❑TY VEK 0 OTHER <br /> +CONTACT PERSO SPECIAL HANDLING—PROCEDURES: <br /> ,:.. .SIGNATURE-Of,. AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby ceaffy.-.#W the above named nadaw is not a hazardousf <br /> waste as defined by 40 CFR Pmt 261 or No 22 of the CaMorniaa Code of 16WAstIMIG,has been Pr�dy <br /> describedand is in pffAw conmori for transportation a toapplicable <br /> 1a '•A it is ciasswed and a of e <br /> to tee w t waste has been heated <br /> a w as a' <br /> 40 a RECEIVING FACILITY <br /> Ota CFR Part 261. <br /> ASE TYPE: <br /> 0 DISPOSAL 0 SLUDGE <br /> 0 CONSTRUCTION 0 WOOD <br /> 0 DEBRIS 0 O ER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER__ S: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> A ESS... <br /> STATE,Z } <br /> " E D DUMP <br /> O DUMP TRANSFER <br /> PRON _ .SjfflUrME_OF' OR AGE OR DRIVER DA S) FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I hereby certifythat the above named material has been <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD: (r0 BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> 0 SOIL <br /> KS <br /> 0 CONSTRUCTION <br /> F CILI C NUMBER DEBRIS <br /> 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE 0 WOOD <br /> ASH <br /> SPECIALO ER <br /> SCHEDULINGP I 3:00 P.M. E DAY PRIORTO EXPECTED ARRIVAL ANY UNSCHEDULEDLOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED I THE LANDFILL THE DAY BEFORE. <br />