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mar+yon L1(;Ottin Butte :❑Ox Mountain 0 Newby Island Forward � <br /> Sanitary Landfill Landfill Sanitary Landfill Sar Landfill Landfill <br /> 901 Bailey Road 28972 Coffin BQRoad 12310 San Mateo Road <br /> Pittsburg, CA 94565 Corvallis, OR 9733D Haff Moon Bay, CA 94019 Milpitas. 9503Land15g goad 9999 S. Austin Road I <br /> Phone(925) -9 9800 Phone (541) 745-2018 Phone (650) 726-1819 Phone (408) 945-2800 PhonMante(209)982-4298 # <br /> I <br /> a, CA 95336 <br /> Fax(925) 458 9891 Fax {541} 745-3826 . Fax(65o) 726-9183 Fax(408)262-2871 Fax(209) 982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADD ESS <br /> 20510 South Ho Drive ��I� <br /> CITY, STATE, ZIP . REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE 95304 MLOVES ❑ GOGGLES ❑ RESPIRATOR I1 HARD HAT <br /> ❑TY-VEK IMSAFETY VEST <br /> CONTACT PERSON <br /> ,Anne 0 SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material fs not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properly - <br /> described,classified and packaged,and is in proper condition for transportation according to applicable <br /> regulations;AND,If the waste is a treatment residue of a previously restricted hazardous waste E <br /> subject to the Land disposal Restrictions,f certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> _accordance with the:requirements o140 CFA Pa 68 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. ` <br /> WASTE TYPE; j <br /> POSAL ❑SLUDGE S <br /> ❑CONSTRUCTION ❑WOOD �fi � <br /> ❑DEBRIS ❑OTHER d <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 20500 South Holly Drive TRACY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Am 1hpipe Oil TtIf-_ <br />` ADDRESS PoSt rdC04 Box 3571 <br /> -CITY, STATE, IP <br /> i <br /> PHONE . _END_DUMP _K LM01VI DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <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 DISPO AL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> -DISPOSE OTHER <br /> ❑ SOIL <br /> REMARKS <br /> ❑ CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS i <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE i <br /> ❑ WOOD <br /> ❑ ASH <br /> ❑ SPLCIAL OTHER <br /> E <br /> SCHEDULING MUST BE.MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO 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 /> i Rev 11/09. SVS-02a GENERATOR COPY MANIFEST** -.1"G111 <br />