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`" A"`xmoultie l.-:!Ox Mountain IJ Newby island n � <br /> Sanitary Landfill Lan,"°►11 'aa Ward <br /> P1 Bailey Sanitary Landfill ( jSanitary Landfill Landfill <br /> y 289ffin Butte Road 12310 SanMateo Road �.✓1601 Dixon Landing Road 98989898 S. <br /> Pittsburg,CA 94565 Corvallis, OR 97330 Austin road <br /> Phone 925 458-9800 Half Moon Bay, CA-94019 Milpitas, CA 95035 <br /> { } Phone (541} 745.2018 Phone {650} 726-1819 Qianit=ca, C:q 9,33G <br /> Fax(925)458-9891 Fax (541) 745-3826 Phone (408) 945-2800 Phone(.209} 9982-4298 <br /> Fax(650) 726=91.0 ''` ': Fax(408) 262-28712_Fax(209) 9'82-1009 <br /> 1G03 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> SUM WASTE ACCEPTANCE NO. <br /> MAILING.ADDRESS <br /> 9914 <br /> CITY, STATE,.ZIP REQUIRED PERSONAL PROTECTIVE Ef'UIF'I Ef;l <br /> PHONE ' si"'kGLOVES ZI GOGGLES U RESPIRATOR X� HARD HAT � <br /> Ems,a <br /> CONTACT PERSON O TY-VEK a .SAFETY VEST <br /> Q - SPECIAL HANDLING PROCEDURES: - -- <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENEas RATOR'S CERTIFICATION:t CFR Pah 261hereby cerllfy thof theat the above named material Is nota hazarflous <br /> Wastdescribed,classified a d packaged.and Isor f{n proper c n&on Californiacode <br /> transportationfiaccord ng to aons,has been pplicable <br /> regulations;AND,Ie Landt the waste Is a treatment residuande of a panireviously restthat lho wastericted hazardousted waste <br /> sub <br /> accordance ce w th the requirementsDisposal ofRestrictions,40 CFR Part 268 andwars no longer a hazardohas us wasteen e s d109ned by <br /> 40 FR Part 261. RECEIVING FACILITY <br /> WASTE TYPE: <br /> O DISPOSAL ❑SLUDGE �� <br /> ❑CONSTRUCTION ❑WOOD <br /> Q DEBRIS O OTHER <br /> ❑SPECIAL WASTE i <br /> GENERATING FACILITY <br /> 20500 Ikcath MW Dfiv sl <br /> €f '►' <br /> TRANSPORTER <br /> NOTES: VEHICLE LICENSE NUMBER TRUCK NUiut#3al <br /> ADDRESS(AiLy nor-3 <br /> r <br /> CITY, STATE, ZIP <br /> f..trA c"A 93241 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATEROL'L,OFF S FLAT-BED VAN _ DRUMS <br /> .Iw <br /> z+ ❑ <br /> CUBIC YARDS <br /> I hereby certify that the above named materialhas been <br /> accepted and to the best of my knowledge the foregoing <br /> is true and accurate: DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE C7rl yCR <br /> REMARKS Li SOIL <br /> ❑ CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> � 1 ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> i <br /> P ; ! ❑ OOD <br /> .lam l r j� f f ASH <br /> R SPECIAL OTHER <br /> $CNEDULII4G MUST i3E MADE PRI'd1i T®3:00 P.M.*NE DAY PRIOR TO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJE CT <br /> TOsREFUSAL UPON AIRRIVAI ONQOING DAILY DELIVERIES MUST BE SiCHEDULED WITH THE LANDFILL THE DAY BEFDRE <br /> Rev tilos -NS, <br /> NS 024 ` GENERATOR COPY' MANIFEST#( "kv ;;A <br />