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mountain ❑ Newby Island `Forwab <br /> Sanitary Landfill Sanitary Landfill 1- <br /> 901 Batley Road 12310 San Mateo Road Sanitary Landfill Landfill <br /> ' Pittsburg.CA 94565 Half Moon Bay,CA 94019 1601 Dixon Landing Road 9999 S Austin Road <br /> Phone(925)458-9800 Phone(650) 726-1819 Milpitas,CA 95035 Manteca,CA 95336 <br /> Fax(925)458-9891 Fax(650)726-9183 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(408)262-2871 Fax_")982_1009 <br /> • NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR 1, r 73, U L4 Q I• � <br /> MAILING ADDRESS �,� 5 WASTE ACCEPTANCE NO. 726 1 LI <br /> CITY,STATE,zIP � + t y REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE t - _ GLOVES O GOGGLES ❑RESPIRATOR U HARD!-IAT <br /> CONTACT PERSO ) ev, , r -0 X7Y VEK Q OTHER <br /> SIGNAT RE OF AUTHORIZED GENT/T11 IL DATE SPECIAL HANDLING PROCEDURES <br /> r G �530 �- g�il�U3 <br /> GENERATOFrS CEFMFICAT1oN I hereby grtdy that tM above <br /> weeq teill <br /> u defined by 40 CFR Part 261 ar hrle 22 of the Caldomu code d rm`p„rabo tW been wove'M <br /> �dona a athe,and q moll hMhn III OW O ccondbon for <br /> tw*l In the hind Delpoaet Restrne I CeArty and werrarrt ft f 2 it brealtirkled een weititig <br /> treated <br /> in <br /> *=-dl with the requvunenta of 40 CFR Part 266 end is no longer a Mzardi waste u dermad by RECEIVING FACILITY <br /> 40 CFA Part 261 <br /> WASTE TYPE a ��i� �• ! i1u_ rtir �;-� , �,, <br /> DISPOSAL O SLUD E <br /> Q CONSTRUCTION Q WOOD <br /> O DEBRIS ❑OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY -t-,, o ,r <br /> — <br /> t 7' <br /> TRANSPORTER ? 1{! c C r <br /> F•if NOTES VEHICLE �_ .3E NUMBER TRUC MBER <br /> l <br /> ADDRESS ` i iQrK Wr <br /> t` <br /> CITY, STATE, ZIP M <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE <br /> ROLL-0FF S FLAT-BED VAN DRUMS <br /> L <br /> s_ CUBIC YARDS <br /> I hereby ceri that the abgve named material a <br /> Is true and accurate s been <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> ' <br /> = I ► � <br /> DISPOSE OTHER <br /> EMARKS � � C3 SOIL <br /> FACILITY TICKET NUMBER i Q CONSTRUCTION <br /> DEBRIS <br /> O NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> ti O WOOD <br /> ❑ASH <br /> Moroi O SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3 00 P M THE DAY PRIOR TO 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 /> GENERATOR COPY MANIFEST N 24787 <br />