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Lj Keller t;anyon LJ UX MUU11LO111 u .®..,..., ­­— <br /> Sanitary <br /> Landfill i <br /> 1 Bailey Road 12310 S t Road 1601 Dixon 'ng d S.Austin Road <br /> Pittsburg,CA Half y,CA 019 Milpitas,CA 95 ant C 95336 <br /> Phone(925) 8-9 Phone{ 0)726-1819 P { } 2 e(2 09)982-4298 <br /> Fax{925} -9891 Fax( 0)726- 1 Fax( ) 2-2871 F {2 } 2-1 9 <br /> MANIFESTNON-HAZARDOUS WASTE <br /> GENE WASTE ACCEPTANCE . <br /> AILING ADDRESS <br /> E®PERSO LPO CIV UI <br /> CITY,STATE,ZIP P ENT <br /> ❑GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> PHONE <br /> ❑TY-VEK ❑OTHER <br /> CONTACT PERSON SPECIAL HA LING PROCEDURES: <br /> S A =AUTHORIZED AGENT/TITLE DATE <br /> GENERATORS GERTIFicATION: hereby carfily#0 the abwe named material is not a <br /> hazardous <br /> waste as defined <br /> described.cwwAw by 4and padcaw0 CFR Part zst or and is in Pro w conow for trarmforlaer"s a.`has been property <br /> ns 10 appilcable <br /> reg°Ia w II ®Uvahnent vokho of a RECEIVING FACILITY <br /> e a the LandDisposalRes i w t °f 0 <br /> iswwdanoa with Ude tsquira of 40 CFR Part . a w ati ReY <br /> 40 CFR Part 261. <br /> WASTE PE: Al 1 <br /> ❑DISPOSAL ❑SLUDGE <br /> ONSTRUCTION ❑WOOD <br /> ❑DEBRIS 0 OTHER <br /> 0 SPECIAL WASTE <br /> ENERATING FACILITY <br /> . ., TRUCK NU BER <br /> P T NOTES: VEHICLE' <br /> r <br /> A S' <br /> C ,'ST E,-ZIP <br /> POEJ <br /> D-DUMPBOITOM DUMP TI r-11 <br /> UTHO F R <br /> DAGENT DRIVER DATE ROLL-O } FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> herbythe abovematerial has been i <br /> accepted tt the best of my knowledge the foregoing DIS D: (TO BE COMPLETED BY LANDFILL) <br /> Is true accurate. <br /> DISPOSE T <br /> ❑SOIL <br /> ICS ❑CONSTRuCTION <br /> DEBRIS <br /> FAC IL TICKET NUMBERFR LE <br /> ASBESTOS <br /> SIGNATURE0F A HOIRIZEDAGENT DATE-- <br /> P' ❑WOOD <br /> , gid f <br /> tt a � ' � E i �` �� ❑ASM <br /> L LOADS <br /> SCHEDULING MUST BE MADE PRK)RTO 3: . Y <br /> REFUSAL THE DAY BEFORE. <br /> TO 1 1 DAILY DELIVERIES L T LL <br /> MANIFEST <br />