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a I(oll tart Landfill <br />9oi <br />, Bailey Road <br />pigsbur9, CA 94565 <br />phone (925) 458-9800 <br />(925) 458-9891 <br />Landfill u Sanitary Landfill -Sa' 'ry Landfill <br />28972 Coffin Butte Road 12310 San Mateo Road 160. on Landing Road <br />Corvallis, OR 97330 Half Moon Bay, CA 94019 Milpitas, CA 95035 <br />Phone (541) 745-2018 Phone (650) 726-1819 Phone (408) 945-2800 <br />Fax (541) 745-3826 Fax (650) 726-9183 Fax (408) 262-2871 <br />NON -HAZARDOUS WASTE MANIFEST <br />r-- - -_ - - <br />Landfill <br />9999 S. Austin Road <br />Manteca, CA 95336 <br />Phone (209) 982-4298 <br />Fax (209) 982-1009 <br />iENERATOR <br />WASTE ACCEPTANCE NO. <br />!AILING ADDRESS I on ,A F <br />fY STATE, ZIP <br />830 — O <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />;I <br />GLOVES Q GOGGLES ❑ RESPIRATOR 3U HARD HAT <br />O TY-VEK V SAFETY VEST <br />,HONE <br />;ONTACT PERSON <br />SPECIAL HANDLING PROCEDURES: <br />SIGNATURE OF AUTHORIZED AGENT / TITLE <br />k <br />DATE <br />G,,ERATOR'S CERTIFICATION: I herehy comity that the above named material is not a hazardous <br />ifornia code of <br />ulations, has <br />le 22 of the <br />R Part 261 or <br />40 <br />;s to +mss classifieyd and Fpackaged, and is i proper nod tion for transpportatio a-cordirgt Papplic�able <br />ds> Is s trash residue of s previously restricted hazardous weata <br />ANO, h <br />rag is <br />suhfad w Restrictions. I certify and warrant thal the waste has been treated in <br />rice with the requirements of 40 CFR Pan 268 and is no longer a hazardous waste as defined by <br />40 CF8Part 261. <br />RECEIVING FACILITY <br />VA TE TYPE: <br />DISPOSAL Q SLUDGE <br />CONSTRUCTION ❑ WOOD <br />DEBRIS ❑ OTHER <br />O SPECIAL WASTE <br />GENERATING FACILITY <br />TRANSPORTER <br />NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br />) / <br />S <br />ADDRESWZ 99 Frontage Rd <br />- <br />END DUMP BOTTOM DUMP TRANSFER <br />STATE, ZIP <br />y cjdmCA95215 <br />;NONE <br />C� ❑ <br />ATURE OF AUTHORIZED AGENT OR DRIVER <br />DATE <br />ROLL -OFFS) FLAT-BED VAN DRUMS <br />.IG <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 />DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br />DISPOSE OTHER <br />❑ SOIL <br />�EMAFIKS <br />❑ CONSTRUCTION <br />DEBRIS <br />=ACID TICKET NUMBER <br />O NON -FRIABLE <br />ASBESTOS <br />` <br />iIGNA R OF LITHORIZED AGENT DATE <br />Q WOOD <br />r- ��I <br />O ASH <br />Q SPECIAL OTHER <br />f <br />DURING Fi UST BE MADE PRIORT1Y3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOAD CT <br />EF \�t1PON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL T DAY BEFOR <br />GENERATOR COPY MANIFEST K [] (1 <br />800lj HoiloflHISNOD 9VH OT90 Z£6 hoz XVA 9f':Z1 80OZ/VO/7.0 <br />