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cA LJ Newby Island m%e Forward <br /> Sanitary Landfilllitary Landfill <br /> 901 Bailey Road Sanitary '' %ndfilf ' Landfill <br /> Pittsburg,CA 94565 0 San Mateo Road 1601 Dixon ing Road 9999 S.Austin Road <br /> Phone(925)458-9800 <br /> Half Moon Say, CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone (650) 726-1819 Phone(408)945-2800 Phone(209)982-4298. <br /> Fax(925)458-9891 Fax(650) 726-9183 Fax(408)262-2871 Fax(209)982-1009 r <br /> i <br /> NON-HAZARDOUS WASTE MANIFEST , <br /> GENERATOR ,! r <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY,STATE,ZIP 41Vr.f f f REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 4/1 d <br /> PHONE ,: - = ❑GLOVES ❑GOGGLES ❑RESPIRATOR HART]HAT } <br /> I <br /> _ r I <br /> Q TY-VEK LI OTHER <br /> CONTACTPERSONCl ► <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE-OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICA'nON: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 a-cording to appticable <br /> regulations;AND,If the waste fs n 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 inde <br /> R Part GB and is <br /> -.accordance RECEIVING FACILITY <br /> I <br /> , w_ith.lhe requirements of 40 CF2no longer a hazardous waste as fined Y <br /> by I , <br /> 44 CFR Part 261. ��- _ .. - I. <br /> WASTE TYPE: Ak <br /> ❑DISPOSAL o SLUDGE <br /> U CONSTRUCTION ❑WOOD ,. �_ _• - ' <br /> ❑DEBRIS Jg OTHER _ <br /> O SPECIAL WASTE 'r <br /> GENERATING FACILITY <br /> r <br /> TRANSPORT9R ✓ NOTES: -VEHICLE LICENSE NUMBER TRUCK NUMBER r <br /> ADDRESS v - 1`C1l i "�i? <br /> CITY,STATE,ZIP ; i <br /> PHONE <br /> FND._DUMP_ _BOTf_OM_DUM.P TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL{OFF(S)•- FLAT-BED VAN DRUMS <br /> 11 � <br /> CUBIC YARDS <br /> I <br /> hereby certify that the above named material has been - <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE ." OTHER <br /> EMARKS O SOIL <br /> O CONSTRUCTION jY - <br /> FACILITY TICKET NUMBER. / DEBRIS <br /> ❑ NON-FRIABLE , <br /> ASBESTOS I <br /> SIG NATURE OF AUTHORIZED AGENT r' DATE / h <br /> Vyoon !1 <br /> Q ASH <br /> �c r <br /> SPEC�ALOTHER <br /> i <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P M.THE DAY PRIORTO 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# 444791 I <br />