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LI mener canyon <br />LI fix Mountain <br />LI Newby 11 -land <br />Sanitary Landfill <br />anitary Landfill <br />Sanita _andfill <br />901 Bailey.Road <br />12310 San. Mateo Road <br />1601 Dixon Landing Road <br />Pittsburg, CA 94565- <br />Half Moon Bay, CA 94019 <br />Milpitas, CA 95035 <br />Phone (925) 458-9800 <br />Phone (650) 726-1819 <br />Phone (408) 945-2800 <br />Fax (925) 458-9891 <br />Fax (650) 726-9183 <br />Fax (408) 262-2871 <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 fitle 22 of the California code of regulations, has been property <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 certify, and warrant that the waste has been treated in <br />accordance with the requirements o140 CFR Part 268 and is no longer a hazardous waste as defined by <br />40 CFR Part 261. <br />NON -HAZARDOUS WASTE MANIFEST <br />Ly <br />Forward <br />Landfill <br />9999 S. Austin Road <br />Manteca, CA 95336 <br />Phone (209) 982-4298 <br />Fax (209) 982-1009 <br />GENERATOR ?;-''�' - �/ '%' r ~-� �:',�'�'�%.% !'= <br />WASTE ACCEPTANCE N0. <br />MAILING ADDRESS <br />CITY STATE, ZIP 1�; ':~r' ` `f% %'%'7 ,`'.r'''; �r�;''` ;'.,' `- <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />GLOVES f YGOGGLES Q RESPIRATOR O HARD HAT <br />0 TY-VEK Q OTHER <br />PHONE e s ;; 1 .S; "int% it.; i <br />CONTACT PERSON <br />SPECIAL HANDLING PROCEDURES: <br />- <br />SIGNATURE OF AUTHORIZED AGENT/ TITLEDATE <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 fitle 22 of the California code of regulations, has been property <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 certify, and warrant that the waste has been treated in <br />accordance with the requirements o140 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 />❑ DISPOSAL ❑ SLUDGE <br />O CONSTRUCTION O WOOD <br />O DEBRIS_ Q OTHER. <br />Q SPECIAL WASTE `. 1' <br />GENERATING FACILITY <br />TRANSPORTER <br />EMS <br />NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br />ADDRESS <br />Y, STATE, ZIP - <br />UPH <br />ONE <br />END DUMP BOTTOM DUMP TRANSFER <br />GNATURE OF AUTHORIZED AGENT OR DRIVER JDATE <br />ROLL-OFF(S) FLAT-BED VAN DRUMS <br />CUBIC YARDS <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 />DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br />DISPOSE OTHM <br />_1 SOIL <br />EMARKS <br />0 CONSTRUCTION <br />DEBRIS <br />FACILITY TICKET NUMBER <br />Q NON -FRIABLE <br />ASBESTOS <br />SIGNATURE OF AUTHORIZED AGENT <br />DATE <br />❑ WOOD <br />*' <br />❑ ASH <br />O SPECIAL OTHER <br />CHEDULING MUST BE MADE PRIORT0 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL *ANY UNSCHEDULED L0AUS Arse auf3Jel, t <br />REFUSAL UPON ARRIVAL, ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br />i; ;A1; SiwF_ER COPY MANIFEST# <br />