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OK eller Canyon Elutt <br /> Coffin' Be <br /> ElOx Mountain ❑Newby Island Q f=orward <br /> Sanitary Landfill Landfil �.. - I y <br /> Sanitary Landfill 5ary Landfill Landfill <br /> 901 Bailey,Road 28972 Cottle I3utte"fioad 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg, CA 94565 Corvallis, OR 97330 Half Moon Bay, CA 94019 Milpitas, CA 95035 Manteca, CA 95336 <br /> Phone(925) 458.9800 Phone (541) 745-2018 Phone (650) 726-1819 Phone (408) 945-2800 Phone (209) 982.4298 <br /> Fax(925)458-9891 Fax(541)745-3826 Fax.(650) 726-9183 Fax(408) 262-2871 Fax (209) 982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR } ; <br /> SUM WASTE ACCEPTANCE NO, <br /> . MAILING ADDRESS <br /> 0500 SOU&HORY Drive 9905 <br /> CITY;STATE; ZIPREQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> TramCA 95304 <br /> CXGLOVES ❑GOGGLES ❑ RESPIRATOR X HARD HAT <br /> PHONE � . <br /> 934-1679 ❑TY-VEK EYSAFETY VEST <br /> CONTACT PERSON <br /> 408my SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE / <br /> y ' eoa <br /> ZlZil <br /> s` GENERATOR'S CERTIFICATION:I hereby certify that the above nafitied material is not a hazardous - _ - <br /> _waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property <br /> described,classified and packaged,and is in proper condition for transpodaYion according to applicable <br /> regulations;AND,It the waste is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I certiry and warrant that the waste has been treated in ;. . . <br /> RECEIVING FACILITY <br /> accordance with the requiremenis'of 40' R Part`268 and is no longer a hazardo0s-waste as defined by :n.,at <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> ❑''COI3STRUCTION ❑WOOD <br /> O DEBRIS. ❑OTHER_ <br /> El SPECIAL WASTE <br /> GENERATING FACILITY <br /> ftva .:l 1C <br /> TRANSPORTER T NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> .10 <br /> ADDRESS <br /> CiT.Y,-STATE; ZIP.: f ;: <br /> DA. -1+4 ; <br /> PNONE',:"�'"""""'� - -. ----END-DUMP— BOTTOM-DUMP-- -^':TRANSFER - <br /> ❑ <br /> 51GNATURE,OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN w DRUMS' <br /> :� . . <br /> o o . <br /> CUBIC YARDS <br /> 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 E O <br /> THER <br /> Q SOIL <br /> REMARKS - <br /> ❑ CONSTRUCTION <br /> -FACILITY/f NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS - <br /> SIGNA URE., F AUTHO lZEQ AGENT I OA_TE <br /> OW00 <br /> a ASH <br /> if+ ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MADE'RIVP,i6 1OR TO 3.00 P.M.THE DAX PRIOR TO EXPECTED ARRIVAL•API Y:LIP1SC1iEDULED LOADS ARE SiJBJECT. �•' <br /> TO REFUSAL UPON ARE ONGOING'DAILY DELIVERIES MAST BE SCHEDULED WIITH THE LANDFILL TH E.DAY SEFOR <br /> MANIFEST#1361 'S <br /> Rev ii/os NS-024 TRANSPORTER COPY' r <br /> i <br /> 1. --- - •-- - - - -- - ---------- �-- -- f -- <br />