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Sanitary Landfill Larlc�fill ., "-w-% ivrvun><alrl I_�r�ewoy isianca t r orwarl " <br /> 901 Salle Road Sanitary.! ndflllb San' Landfill <br /> y <br /> 289i �ffin Butt Landfill <br /> Road 12314 San Mateo Flood 4601 Dixon Lundin Road oPittsburg, CA 94565 Corva Ids, OR 97330 g 9999 S.Austin Road <br /> Phone 925 458-9800 Halt Moon Bay, CA 94019 'Milpitas, CA"95435 Manteca. CA g 3:33B } <br /> ( ) Phone (541)745-2018 Phone (650) 726.1819 Phone(408) 945-2840 R <br /> Fax (925)458-9891 Fax (541)745-3826 Phone (2U9; 982-429P,Fax(650)726-9183 Fax (408)262-2871 Fax(209) 9f11:-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> S tCel !a WASTE ACCEPTANCE NO. _• � <br /> MAILING ADDRESS i <br /> 9914 <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE <br /> PHONE , CYGLOVES ❑GOGGLES ❑ RESPIRATOR X1ARL3 HAT <br /> CONTACT PERSON' <br /> LJTY-VEK :SAFETY VEST <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE <br /> DATE <br /> .J r' "" <br /> Gl I tl`ATOR'S CERTIFICATION;I hereby certify that the above named material is-hot a hazaidous II! <br /> waste as defined by 40 CFR Pad 261 or title 22 of the California code of regulations,has bees property <br /> described,classified and packaged,and is fn proper,condition for transportation according to applicable ' <br /> regulations;AND,If the waste Is a treatment residue of a previously restrfctad hazardous waste <br /> subject to the Land Disposal Restrictions,f certify and warrant that the waste has been treated in <br /> accordance with the requirements or 40 CFR Part 268 and is n6 ionger a hazardous waste as d lined by RECEIVING FACILITY j .w <br /> 40 CFR Part 261. - <br /> WASTE TYPE: --- <br /> I-D-I319POSAL a SLUDGE <br /> 0 CONSTRUCTION ❑WOODQ DEBRIS <br /> ❑OTHER ----- <br /> ©SPECIAL WASTE <br /> GENERATING FACILITY" <br /> I <br /> it <br /> A. <br /> a`w� i w <br /> TRANSPORTER <br /> NOTES: VEHICLE LICENSE NUMBER TRUCK N!,a4RE_R <br /> Thn <br /> ADDRESS ,,; -;}` �� �• <br /> affix. <br /> CITY, STATE, ZIP <br /> PHONE END DUMP BOTTOM DUMP TR,'�fJSFEf; <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DIRUDOS <br /> ❑ Ll <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 <br /> is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE UTP if 1 i <br /> REMARKS ❑ SOIL �ry <br /> O CONSTRUCTION <br /> FACILITY TICIGET..NUMBER DEBRIS <br /> O NON-FRIABLE ----- <br /> ASBESTOS <br /> 81GNATU 1z"; OFA zHORIZED'AGENT.. <br /> f ' <br /> , <br /> -3 PECIAL,OTHER <br /> US tr BE MADE PRIOR Ti�3:04 P.M.THE'DAY PRfl6R,Tt?.EXPECTED.ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> rr ' tjSAL5U�0A+I ARRIVAL O 01140 DAILY DELI'UER!iS MUST DE"id' <br /> HE®ULE®WITH THE LANDFILL THE DAY BEFORE <br /> ._`�....S.h GENERATOR COPY MANIFEST# µ <br />