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1' •+ � <br /> Sa�i�tary,LandfIIJ �' ` Sanitary Landfill Landfill <br /> -901 BBdejr Road' '-w:Y " = 12314 San Mateo Ao 1601 Dixon Landing Road 9999 SdAust111 Road <br /> ' Pittsburg,-CA 94565 Haft 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 <br /> GENER R WASTE ACCEPTANCE N0, <br /> MAILING ADDRESS 61 <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE 0 GLOVES 0 GOGGLES 0 RESPIRATOR C4 HARD HAT <br /> O TY-VEIL 0 OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE !{ <br /> fr / <br /> * 7/zy L <br /> GENERATOR 5 CERTIFICATION I hereby certify that the above named materiai is not a hazardous <br /> waste as dented by 40 CFR Part 261 or title 22 of the California code of regulations has been property <br /> described classified and packaged and w in proper condition for transportation a,cordmg to applxable <br /> regulations AND,If Me waste Is a treatment residue of■previously restricted hazardous waate <br /> subject to the Land Disposel Restrictions, I certify and warrant that the waste has been treated m RECEIVING FACILITY <br /> accordance wrt3i the requirements of 40 CFR Part 268 and is no WNer a hazardous waste as defined by <br /> ' 40 CFR Part 267 <br /> WASTE TYPE <br /> ❑DISPOSAL 0 SLUDGE <br /> CI CONSTRUCTION O WOOD <br /> ' 0 DEBRIS THER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> I vr�0 <br /> TRANSPORTER M NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS j,t <br /> CITY, STATE,ZIP / f <br /> J <br /> ' PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROL -O F(S) FLAT-BED VAN DRUMS <br /> * l <br /> /7 a <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foreg In DISPOSAL METHOD (TO BE COMPLETED 8Y LANDFILL) <br /> Is true and accurate <br /> DISPOSE OTHER <br /> 0 SOIL <br /> REMARKS <br /> CONSTRUCTION <br /> /W DEBRIS <br /> FACILITY TICKET NUMBER ❑NON-FRIABLE <br /> r ASBESTOS <br /> SIGNATURE OF AUTHORIZ D AGENT DATE <br /> 0 WOOD <br /> 0 ASH <br /> O SPECIAL OTHER <br /> SCHEDULING MUST BEM PRIORTO 3.00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL.a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON AR MV <br /> ONGOING DAILY DELIVERIES OUST BE SCHEDULED WITH THE LANDFILL.THE DAY/BE�jF{ORE <br /> $6 5 2 �(V y' ' <br /> GENERATO COPY %§ = h � h`�', R <br />