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Iler Can on ❑ 7a untai,n ❑ Newby Islam Forward <br /> El Ke ' <br /> Y <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,CA 94565 Nall Moon Say,CA 9401,9 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(408}262-287 <br /> Fax(925)458-9891 Fax(650)726-9183 i" Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> ff <br /> MAILING ADDRESS "� �- <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT E <br /> r^ /6 _LOVES -J*GOGGLES O RESPIRATOR �AARD HAT j <br /> PHONE �~ <br /> _ P. — '. Q TY V LK U OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OFA QRIZE ENT 1 TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 GFR Pan 261 or title 22 of the California code of regulations,has been properly <br /> desaribad,classified and packaged,and is in proper condition for transportation a-cording to applicable " <br /> regulations:AND,11 the waste Is a treatment resldu*of a previously restricted hazardous waste <br /> subject to the Land Disposal Restnetions,I certity and warrant that the waste has been treated in RECEIVING FACILITY " <br /> accordance with the requirements of 40 CFR Part 26B and 4 no longer a hazardous waste as'defined by <br /> 40 0FR Pan 26 i. <br /> WASTe-F-YPE- 11 i _ /,..moi k-112 <br /> bisPOSAL Q SLUDGE <br /> 'Q CONSTRUCTION O WOOD <br /> Q DEBRIS Q OTHER <br /> 13 SPECIAL WASTE <br /> GENERATING FACILITY " <br /> r .e. <br /> ° �. <br />€ NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> TRANSPORTER <br /> ADDRESS (�s 7� a <br /> CITY, STATE,ZI -i <br /> PHO1V&, <br /> END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> I <br /> t U j .. U A <br /> CUBIC YARDS <br /> I hereby certify that the above named material hes 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 /> REMARKS <br /> j ❑CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER 1:1NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT <br /> DATE . <br /> # Q WOOD <br /> DASH <br /> 7 1 ft x - <br /> * / A ./ i Ct:SPE CIAL OTHER , <br /> Ing <br /> SCHEDGLING MIDST BE MADE PRIOR TO 3:00 P.M.THE DAYPRIORTO.EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> r TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE.LANOFILL THE DAY BEFORE: <br /> MANIFEST It <br />