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E] Ke I?,r,Canyon ElOx Mountain ElNewby Island ❑ Forward <br /> fSalnifary 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 Moan Bay,CA 94019 Milpitas,CA 95035 Manteca, CA 95336 <br /> RhoneJ925)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 <br /> GENERATOa WASTE ACCEPTANCE NO. <br /> 1 a <br /> MAILING ADDRESS I _ r <br /> CITY STATE ZIP 4 j REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> I, PHONE ❑GLOVES 0 GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> ❑TY-VEK 0 OTHER <br /> CONTACT PERSON t�� ' "� :� SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE: <br /> �k /Z 7 y �` <br /> GENERATOR S CERTIFICATION I hereby oerttfy that the above named materiel is not a hazardous <br /> waste as defined by 40 CFR Part 261 or We 22 of the California code of regulations has been progeny <br /> deacnbed classihed and packaged and Is in proper oondrlron for transportation a-cording to applicable <br /> regulations AND if the waste is a tnetment residue of a previousty 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 Pert 268 and is no tonger a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ❑DISPOSAL w O SLUDGE <br /> CONSTRUCTION 0%MOOD <br /> ❑DEBRIS THER <br /> ©SPECIAL WASTE <br /> 4Y1 <br /> GENERATING FACILITY r <br /> rt i•-..{ I� �gY n <br /> 1 �1�� �� �34 � 4�) <br /> I i <br /> TRANSPORTER ,, 1 NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> P � r <br /> ADDRESS <br /> CITY,STATE,ZIP it ,i <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> l 1 <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 /> ❑ SOIL <br /> EMARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ <br /> ASBESTOS ASBE <br /> SIGNATURE OF AUTHOR IZ D A EN DATE <br /> L ❑WOOD <br /> O ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORT0 3 00 PM THE DAY PRIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> MANIFEST* r%.1;91 n <br />