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u rtent:r %.-il"yon u ux mounialn u Newdy island V Forward <br /> Sanitary Landfill S `­tary Landfill Sanitary L� dfill Landfill <br /> 901 Bailey Road 12k, ..,'San Mateo Road 1601 Dixon La.,.)g Road 9999 S.Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay, CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925) 458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)9824298 <br /> Fax(925)458-9899 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 ' <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR / / / r" t ,r' WASTE ACCEPTANCE NO. <br /> /_ <br /> MAILING ADDRESS �J _ ,�-_',�'•: „-,� <br /> CITY, STATE,ZIP 7f, ,REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE t /y-ti/L_C _ 44d i ❑GLOVES ❑GOGGLES O RESPIRATOR ,(dHARD-HAT <br /> C 0 ! ; r _//A-79'' � ID TY VEK ❑OTHER ri��� <br /> CONTACT PERSON A , ,..�. SPECIAL HANDLING PROCEDURES: <br /> hol 1V <br /> SIGNATURE OF A'THORIZED AGENT-/-T4,TLE / DATE, <br /> 4I ...-- <br /> a � , <br /> GENERATOR'S CE F IFiCATION:I heisby certify that tha'above named material is nota hazardous <br /> was1p I J fined by(40 CFR Peri 26)'or title 22 of the California code of regulations,has been properly " <br /> descdb'sd,classified and packaged land is in proper ccMiliortfor transportation a-cording to applicable <br /> regulations;AND, the wasteT�s/treatment residue of a previously iestrlcted hazardous waste <br /> subject to the Lan Disposal Rest&Oons,1 certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the Ldquirement's of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> w 46 GFR Part 26Lµ - _ <br /> WAST_ E TYPE: <br /> •ISPOSAL ❑SLUDGE ��51 <br /> !_: O CONSTRUCTION- _ ❑WOOD <br /> U DEBRIS ❑OTHER <br /> Cl SPECIAL WASTE <br /> GENERATING FACILITY t" <br /> oe <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> 41-Zi- 42 <br /> ADDRESS ..e . { ;1 f r 91 < 7 r <br /> CITY, STATE, IP <br /> i7yONE ._/._: •,,� _ - r .%. r5.-� ,•-__„� ,_� ---- _ ___EN .DUMP___.---BOTTOM D_LIMP__. . TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE 1 ROL -OFF(S) FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> ! hereby 'certi <br /> .fy tFaat'tlie above named material has been <br /> accepted Sand to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANa>=ILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> ❑SOIL <br /> REMARKS ” <br /> ❑CONSTRUCTION <br /> I FACILITYTICKET NUMBER DEBRIS <br /> ❑ NON FRIABLE T <br /> SIGNATUE�OFAUTHORIZEDAGENT DATI= r'� ' ASBE$TOS <br /> R <br /> i ) r 0 woo <br /> f ❑SPECIAL OTH6 <br /> 1 r a <br /> SCHED'U' LING-MUST-BE MADE PPIORTO 3:00 P M.THE DAY PRIOR TO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE"SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE. DAY BEFORE. <br /> GENERATOR COPY MANIFEST# 4 4 43 2 6 <br /> A. <br />