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%.'C111yu1f u ux,nnaunialn LJ Newby Island ❑ Forward <br /> Sanitary Landfill �Ittar.y Landfill Sanitary,-•ndfill Landfill <br /> 901 Bailey Road 0 San Mateo Road 1601 Dixon ting Road 9999 S.Austin Road <br /> tz Pittsburg, CA 94565 • Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 n" Phone (650)726-1819 Phone(408)945-2800 Phone(209)98274298 <br /> Fax(925)458-9891 - Fax(650) 726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING AgpRt=SS f <br /> CITY,,STATE, IP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHON / `"�`'`I°'4" '� ❑GLOVES O GOGGLES ❑RESPIRATOR )b HARD HAT,, <br /> Er. ..-7 r f. r-- <br /> ❑TY-VEK C1 OTHER <br /> CONTACT"PERSON _ <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED NT t7'C DATE <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 tills 22 of the California coda of regulations,has been property <br /> described,classified and packaged,and is in proper ccnditlon for transportation a carding to applicable rr <br /> regulations;AND,11 the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY' ty f <br /> accordance with the requirements of 40 CFR Pari 266 and is no longer a hazardous waste as defined by <br /> -40`CFR Part 261:_ _ _ w, _ 33 _ <br /> �� ..- _...,....� <br /> WASTE TYPE: <br /> ❑DISPOSAL C1 SLUDGE <br /> U CONSTRUCTION ❑WOOD <br /> b DEBRIS ❑_ OTHER <br /> D SPECIAL WASTE <br /> t GENERATING FACILITY ' <br /> 511 <br /> TRANSPORTER j is-'' /7. NOTES: VEHICLE LICENSE NUMBERTRUCK NUMBER <br /> ADDRESS <br /> f i.— ✓ <br /> CITY,STATE,ZIP <br /> PFfONE, ._ENPtPUMP— - BOTTOM-DUMP_.--.�_TRANSFER <br /> SIGNATURE OF`AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S)­ FLAT-BED ,VAN DRUMS <br /> 1 <br /> CUBIC YARDS.. <br /> __ hiffLiby certify that the atiov_eiiamed material hasbeen - <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 OTHER <br /> i <br /> EMARKS ❑541E k <br /> [],CONSTRUCTION- <br /> FACILJTY TICKET NUMBER D1=RBIs ' <br /> R NON FAiABLE `t <br /> _ s•" n.ASBESTOS . 1 l <br /> SIGNATURE OFAUTHORIZED AGENT _ DATE - f 1. <br /> �= l i WOOD <br /> ✓ l O <br /> ASH` <br /> *' <br /> C]SPEGIALOTR <br /> : .... <br /> A <br /> f <br /> SCHEDULING MUST BE MADE PR;ORTO 3:00 P.M.THE DAY PRI ORTO EXPECTED ARRIVA,L '7 4Y'UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDt1LED'-WylTli"TF4E£LANDFiLL THE DAY BEFORE. <br /> TRANSPORTER COPY _1 MAN(FEST# <br /> 444625 } <br />