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isuvwNr Iw10114, lJ 1 vl"Clu <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfili Landfill <br /> 901 Bailey Road 310 San Mateo Road 1601 Dixc }pding Road 9999 S.Austin Roac <br /> Pittsburg,CA 94565 1idif Moon Bay, CA 94019 Milpitas,CA 9503E Manteca, CA 9533E <br /> Phone(925) 458-9800 Phone(650)726-1819 Phone (408) 945-2800 Phone(2D9)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 — <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE O.GLOVES 0 GOGGLES O RESPIRATOR ®'HARD HAT <br /> ❑TY--VEK OOTHER <br /> CONTACT PERSON <br /> _ SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE . DATE <br /> GENthATOR'S.EERnFICATION:I baeby candy IMI file above named material is not a hazaNaua <br /> waste as defined by 40 CFR Pert 261 or title 22 of the California ootle of regdetioru,bas been property <br /> described.daasiMd and pecaegeo,and is in proper conpilbn for transportation e-cardirlg to applicable <br /> regulations:ANO,N the waata b a Ineatltlerd mldlr of a pneNeusfy mbktM Mi ardoua".as <br /> �d Mthew Land Rnlriclions,I certify aha warrant Neal Me waste Ilse been treated in RECEIVING FACILITY <br /> requirements of 40 CFR Past 268 and is no longer a hazardous waste as defined by <br /> 40 LFR Part 261. <br /> WASTE TYPE: <br /> kFDISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION 0WOOD <br /> O DEBRIS O OTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1413 Bmirbon STreet: StocktYon, CA ?5204 <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS /' C ' t <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> ❑ U ❑ ❑ <br /> CUBIC YARgS., <br /> I hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing <br /> is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS O SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> SIGNATURE OFAUTHORIZED AGENT DATE ASBESTOS <br /> O WOOD <br /> �- OSPECIALOTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUB <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEF <br /> GENERATOR COPY MANIFEST M 2 6 ( <br />