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DaKe 1,er:Canyon ❑Coffin Butte ❑Ox Mountain ❑Newby Island 'N*orward <br /> Sanitary Landfill Landfill Sanitary landfill Sar };pry Landfill Landfill lLr <br /> X901 Bailey Road 28972 Coftin Bu e Road 12310 San Mateo Road 1601 Vixon Landing Road 9999 S.Austin Road <br /> LT `Pjttsburg, 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 /> EGENER4ATOR <br /> NON-HAZARDOUS WASTE MANIFEST <br /> WASTE ACCEPTANCE NO. <br /> REWIRED PERSONAL PROTECTIVE EQUIPMENT .� LOVES U GOGGLES U R"ESPIRATO.R Q�RD HAT <br /> UTY-VEK .a- AFETYVEST . <br /> ACT PERSON <br /> SPECI�L HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIRCATION:I hereby certify that the above named materia , nota hazardous - - <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regUahons,has been properly <br /> r described,classified and packaged,and is in proper condition for transportation a-carding to applicable <br /> rogulahons;AND,if the waste Is a treatment residue of a previously restricted hazardous waste - I <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has heen treated in RECEIVING FACILITY - <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: l <br /> U CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY ; <br /> TRANSPORTER... . _ NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER . <br /> fN <br /> F ADDRESS <br /> s i <br /> I <br /> u CITY,STATE,ZIP <br /> PHONE - -END DUMP BOTTOM DUMP . - -TRANSFER- <br /> SIGNATURE OF AUTHORIZED AGENT OR DF IVF DATE ROLL-OFFS) FLAT-BED VAN DRUMS.. <br /> ❑ ❑ ❑ ❑ <br /> CUBIC YAR__ <br /> DS <br /> f <br /> J y certify that the abode named material has been - <br /> accepted and t0 the best of my knowledge the fore.going .- DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> F#EMARKS ❑SOIL <br /> y U CONSTRUCTION <br /> " FACILITY TICKET NUMBEIR DEBRIS <br /> IZI NON-FRIABLE <br /> �� -- ASBESTOS <br /> tw SIGNATUR OF AUTU RIZEL AGEN PATH' <br /> WOAD - <br /> t f �" ASAI <br /> L /�`r �` s Cl SPECIAL OTHER y <br /> s.. <br /> SCHEDULING MUST BE MADE ISR RTO 3:00 P M.THE DAY PRIOR TO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUSJEC7 <br /> TO REFUSAL UPON ARt4IVAr' ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE.�ANDFlIiR THE <br /> M [)AY B:EFOFIi=:. <br /> AN I FEST'# - <br /> r�t� RAT OR cOPy <br />