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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 /> Pittsburg,lCA 94565 Half 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 /> GENEROR WASTE ACCEPTANCE NO <br /> MAILING ADDRESS ` - A _ <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> r =14, ' I- E `� f ❑GLOVES U GOGGLES ❑RESPIRATOR U HARD HAT <br /> PHONE <br /> U TY-VEK U OTHER <br /> CONTACT PERSON i SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT 1 TITLE DATE �� ¢ <br /> df 1 f `I v if <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or htte 22 of the Cahtorma code of regutations has been property <br /> desenbed classified and packaged and rs in proper condition for transportation a-cording to applicable <br /> regutatrons AND,If the waste Is s"aUnent residue of s 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 ❑SLUDGE <br /> 0 CONSTRUCTION U WOOD <br /> ©DEBRIS IrTHER <br /> d SPECIAL WASTE <br /> j"`f <br /> GENERATING FACILITY <br /> 1 <br /> TRANSPORTER t ' NOTES VEHICLE LICENSE <br /> ICENSE NUMBER TRUCK <br /> RUCK NUMBER <br /> rIF ' /fFr' i�: <br /> ADDRESS rf f� <br /> CITY, STATE,ZIP , ° ` / y <br /> PHONE �. t f „ END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> 74 <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the forego ing <br /> DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate �, <br /> DISPOSE OTHER <br /> ' U SOIL <br /> r <br /> 1wMARKS <br /> --, ❑ CONSTRUCTION <br /> t r DEBRIS <br /> FACILITY TICKET NUMBER f r <br /> UNON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT r DATE <br /> .. { ❑WOOD <br /> •-- •' j ❑ ASH <br /> ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE IIA DE PRIORTO 3 OO P M THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJ <br /> TO REFUSAL UPON ARFVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFO <br /> rntsv MANIFEST# 65230 <br /> -rr,rwrcrnoT�o <br />