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❑ "eller Canyon ❑ Ox Mountain ❑ Newby Island ❑ Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pi"sburg,4CA 94565 Hali Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> `Phone(925)458-9800 Phone(650)726-1819 Phone(408) 945-2800 Phone(209)982-4298 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST 4 <br /> GENER*tOR f'1 P WASTE ACCEPTANCE NO <br /> l � <br /> MAILING ADDRESS <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> F`^ 'V = '� /� - �' O GLOVES O GOGGLES O RESPIRATOR O HARD HAT <br /> PHONE <br /> O TY VEK O OTHER <br /> CONTACT PERSONi , SPECIAL HANDLING PROCEDURES <br /> ., <br /> i. ,r <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE ! r <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material rs not a hazardous <br /> waste as defined by 40 CFR Part 261 or hae 22 of the California code of regulations has been properly <br /> dascnbed classified and packaged and is in proper condition for transportation a-cording to applicable <br /> regutahoru AND,11 the waste Is a Ireairnent rssldus of•previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions I 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 longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> O DISPOSAL O SLUDGE <br /> O CONSTRUCTION O WOOD <br /> O DEBRIS UVOTHER <br /> O SPECIAL WASTE ✓( <br /> GENERATING FACILITY <br /> 1 � <br /> dGr �J <br /> TRANSPORTER �� _�.-` !-"'" ,--t'" MOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> J <br /> CITY, STATE,ZIP , ' ' t � <br /> PHONE ; d END DUMP BOTTOM DUMP TRANSFER <br /> r f ! /' ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> l ❑ ❑ ❑ ❑ <br /> 1��nL) » <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foreg6ingJ DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate i �, <br /> DISPOSE OTHER <br /> r O SOIL <br /> EMARKS 1 <br /> -� Q CONSTRUCTION <br /> FACILITY TICKET NUMBER i t DEBRIS <br /> O NON-FRIABLE. <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE O WOOD <br /> 1 O ASH <br /> ❑ SPECIAL OTHER <br /> SCHEDULING MUST BEM DE PRIORT0 3 00 P M THE DAY PRIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJE <br /> TO REFUSAL UPON ARMVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE: LANDFILL THE DAY BEFFO <br />