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061%ountain El Newby Island <br /> Sanitary ill Sanitary Landfill Landfill <br /> ;;�V(925) <br /> 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> 565 Half y,CA 94019 ilpi ,CA ant ,C 95 6 <br /> 5)458-9 0 Phone( )726-1819 Phone( ) 2 Phone(2 )982-4298-9891 Fax( 0)726-91 Fax( )262-2871 Fax(2 09)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> MAILING ADDRESS <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> T = D GLOVES D GOGGLES D RESPIRATOR D HARD HAT <br /> PHONE <br /> D TY VEIL D OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING R EVES: <br /> SIGNAIU13g OF AVIHOBIZED AGENT/TITLE DATE <br /> Z___' (j t Y, <br /> GENERATOR'S CERTIFICATION:I hereby certify I alt the above named material is not a hamudoua <br /> waste as defined by 40 CFR Part 281 or fift 22 of the Calikunia code of <br /> described,classified and packaged,and is in a regulations, to applicable <br /> regulations;AND,If the waste is a weabnent residue of a previously msbkftd hamordous waste <br /> m4ect to the Land Disposal Reskictions,i cenify and warrant that the waste has been treated in RECEIVING FACILITY <br /> moordance with the of 40 CFR is not a w as by <br /> 40 CFR Fart 2&1. <br /> ATE PE: <br /> D DISPOSAL D SLUDGE <br /> D CONSTRUCTION D WOOD <br /> D DEBRIS UOTHER <br /> D SPECIAL WASTE <br /> GENERATING FACILITY <br /> +Ez4 fid'«'" <br /> TRANSPORTER S: VEHICLE LICENSE NU U NUMBER <br /> AD E <br /> GI 'S E,ZIP <br /> PHONE END DUMP BOTTOM DUMP E <br /> S1011AMAE5 <br /> .,®OFAUTHORIZED AGENT OR DRIVERDATE RO (S) FLAFLAT-BED VAN <br /> U S <br /> LIQ_'_4 a,,' <br /> CUBIC YARDS <br /> I hereby certify# t the above named material has been <br /> accepted and to the best of my knowledge the foregoingDIS D: (TO BE COMPLETED BYLANDFILL) <br /> is true <br /> DISPOSE OTHER <br /> REMARKS D SOIL <br /> D CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> DNON-FRIABLE <br /> ASBESTOS <br /> SIGNATPRE OF AUTHORIZED AGE <br /> U ASH <br /> d! ggg ff <br /> PP j <br /> ( ED SPECIAL OTHER <br /> 3:00 PJA.THE DAY PRIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TTI OCIT110AI 11n^&I A®@!1D®® _----- <br />