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r �, ,,,~, t..a„y�„ <br />vx Ev>tou��aln <br />U Newey Island <br />1=J, Forward <br />Sanitary Landfill <br />r itary Landfill <br />Sanitary idfill <br />Landfill <br />901 Bailey,9oad <br />Pittsburg, CA 94565, <br />- 1. 0 San-Matpo Road <br />Half Moon Bay, CA 94019 <br />1601 Dixon La ling Road <br />Milpitas, CA 95035 <br />9999 S. Austin Road <br />Manteca, CA 95336 <br />Phone (925) 458-9800 <br />Phone (650) 726-1819 <br />Phone (408) 945-2800 <br />Phone (209) 982-4298 <br />Fax (925) 458-9891 <br />Fax (650) 726-9183 <br />Fax (408) 262-2871 <br />Fax (209) 982-1009 <br />WASTE TYPE: <br />NON -HAZARDOUS WASTE MANIFEST <br />GENERATOR ; i' 7- 01`L <br />WASTE ACCEPTANCE N0. <br />MAILING ADDRESS <br />CITY, STATE, ZIP <br />{` ` " <br />REQUIRED✓ PERSONAL PROTECTIVE EQUIPMENT <br />FYGLOVES ,� <br />GOGGLES Q RESPIRATOR HARD HAT <br />" <br />O TY-VEK O OTHER <br />PHONE <br />,e , � C !,�,� ' .S r i �t,l° Gi. ��''- r' <br />CONTACT PERSON <br />SPECIAL HANDLING PROCEDURES: <br />SIGNATURE OF AUTHORIZED AGENT/ TITLE <br />I DATE <br />GENERATOR'S CERTIFICATION: I hereby certify that the above named material is not a hazardous <br />.waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations, has been properly <br />described, classified and packaged, and is in proper condition for transportation a -cording to applicable <br />regulations; AND, If the waste Is a treatment residue of a previously restricted hazardous waste <br />subject to the Land Disposal Restrictions, i certity and warrant that the waste has been treated in <br />accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br />40 CFR Part 261. <br />RECEIVING FACILITY <br />WASTE TYPE: <br />O DISPOSAL ❑ SLUDGE <br />❑ CONSTRUCTION O WOOD <br />Q DEBRIS Q OTHER. <br />•SPECIAL WASTE '%'`='�'f7='"' {';'r�,�/jr <br />GENERATING FACILITY <br />�.r-'C"f. ,;�i jrii„�;.,,,���`-" ::yrf: :1' �i .1 '%..moi s—',�� •%Cf rf �') i..; ".. <br />TRANSPORTER <br />NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br />ADDRESS <br />CITY, STATE, ZIP -r . <br />PHONE ; '. <br />END DUMP BOTTOM DUMP TRANSFER <br />SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE <br />J ❑ ❑ <br />ROLL-OFF(S) FLAT-BED VAN DRUMS <br />`- <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. <br />CUBIC YARDS <br />R <br />DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br />DISPOSE OTHER <br />❑ SOIL <br />REMARKS <br />❑ CONSTRUCTION <br />DEBRIS <br />FACILITY TICKET NUMBER <br />Q NON -FRIABLE <br />ASBESTOS <br />SIGNATURE OF AUTHORIZED AGENT _ ._ <br />DATE <br />ti <br />PASH <br />OTHER ' <br />CHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL* ANY UNSCHEDULED LOADS ARE SUBJECT <br />:'REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br />TRANISPO"PTER ;-CCOPY MANIFEST # � �' <br />