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❑ KeJ1er,Canyon El Ox Mountain ❑ Newby Island E] Forward <br /> °,Sen6ry Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Batley Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca, CA 95336 <br /> Rhone(925)458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4291 <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 I r` <br /> CITY,STATE ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE O GLOVES Q GOGGLES O RESPIRATOR 0 HARD HAT <br /> 0 TY-VEK 0 OTHER <br /> CONTACT PERSON ,,�Iwr � "` � tr � <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT I TITLE DATE <br /> l/Zij,)V <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFH Part 26t or btle 22 of the California coda of regulations has been property <br /> described das'.h.and packaged and is in proper condition for transportation a-cording to applicable <br /> regulations AND If the waste Is a treatment residue of•previously restricted hazardous waste <br /> sub}ect to the Land Disposal Restrictions 1 certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no tonger a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> O DISPOSAL O SLUDGE <br /> O CONSTRUCTION O VY00D <br /> O DEBRIS THER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> I <br /> TRANSPORTER .� ,. / -- x 1 NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS Y „ r - f f;?b U� <br /> CITY,STATE,ZIP 1j. <br /> � r f <br /> PHONE v / ; ' END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE 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 DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate <br /> DISPOSE OTHER <br /> O SOIL <br /> REMARKS <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER r DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED A EN DATE Q WOOD <br /> O ASH <br /> O SPECIAL OTHER <br /> INNER <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 PM THE DAY PRIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJEt <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFOR <br />