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•7- � l „uttW uUx moytarn L1Newby Island Forward <br /> Sanitary Landfill - Landfill Sanitar Landfill Sari#ary Landfill Landfill <br /> 901 Bailey Road 28972 Coffin Road 12310 San Mateo Road 16� on Landing Road 9999 S.Austin Rad <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) 982-1043 <br /> NON-HAZARDOUS WASTE MANIFEST j <br /> GENERATOR <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> 20500 South o f: ' 9905- E <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT j <br /> PHO E C GLOVES ❑ GOGGLES " D RESPIRATOR Jul HARD HAT <br /> i <br /> Q TY-VEK CKSAFETY VEST <br /> C 0 N ACT PERSON <br /> Awe C�M SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> �, 7* L -!) <br /> GENERATOR'S CERTIFICATION:i hereby certify that the above named 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 properly <br /> described,classified and packaged,and is in proper condition for transportation according to applicable k <br /> regulations;AND,If the waste Is a treatment residue of a previously restricted hazardous waste f <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> I <br /> accordance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> .40 CFR.PM261. . <br /> WASTE TYPE:. <br /> SPOSAL ❑SLUDGE <br /> 61 N -- <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING.FACILITY <br /> 20500 SOuth Holly Ihivve TRACY _ <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS- Oil <br /> C <br /> T-U CA 95241 <br /> PHOKE END DUMP BOTTOM DUMP TRANSFER ! <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> CUB C S <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. _ DISP L METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS - R SOIL - <br /> ,. C] CONSTRUCTION <br /> FACILITY IC -FT NUMBER DEBRIS <br /> ❑ NON-FRIABL <br /> ASB STOS <br /> SIGN IWR OF AUTH IZED AGC-KT D <br /> i 4 , Q W01D <br /> F / { ASH j <br /> Q SPECIAL OTHER <br /> E <br /> SCHEDULING MUST BE MADE PRIO0 3:00 R.tA.THE DAY PRIOR TO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> R <br /> TO REFUSAL UPON ARIVAL.ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH_ THE LANDFILL THE DAY BEFORE. . <br /> ReV 11/09 NS-024 r GENERATOR COPY MANIFEST# 6:191 <br />