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I_J ptener [,anyan U ux IViIIJur>tllc ll" u 1'rvriruy 101a11aa 1^1 <br /> •,.,,...� <br /> Sanitary Landfill .Sar'tary Landfill Sanitary L?^dfill Landfill l <br /> 901 Bailey Road 12an Mateo Road 1601 Dixon Laid Road 9999 S.Austin Road i <br /> Pittsburg,CA 94565 Half Moon Bay, CA 94019 Milpitas,CA 95035 Manteca, CA 95336 <br /> Phone(925)458-9800 '-Pllone (650)726-18a— "4 `> 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 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR yr 4 WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS �.,J <br /> CITY,,STATE, ZIP ? t REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ❑GLOVES <br /> ;'GOGGLES ❑RESPIRATOR HARD HAT <br /> PHONE . <br /> 4 ❑TY-VEK ❑OTHER <br /> CONTACTPERSONf,," ' <br /> � � SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT?TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named materW is not a hazardous <br /> waste as defined by 40 CFR Part 261 or tkIe 22 of the California coda of regulations,has been property <br /> described,classified and packaged,and is in proper condition for transportation a cording to applicable <br /> regulations;AND,if 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:. - ? ' <br /> accordance with the requirements of 40 CFR Pat 266 and is no longer a hazardous waste as defined by <br /> CFR Part 261. <br /> WASTE TYPE. - <br /> ❑DISPOSAL- ❑SLUDGEr ` , ' <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS .OTHER <br /> ❑SPECIAL WASTE I <br /> GENERATING FACILITY ') 647 <br /> is <br /> TRANSPORTER ;~ NOTES: VEHICLE LICENSE NUMBS. TRUCK NUMBER. = � <br /> ADDRESS <br /> CITY,.STATE,ZIP r <br /> PHONE `. ,-.f -__ �__- —_ «- ---' --- _ END DUMP BOTTOM DUMP TRANSFER <br /> IX <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-O"FF(S)­ 'FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> `£ a, <br /> I <br /> CUBIC YARDS - <br /> I <br /> I ft reby certify"that the above named Mgter'idl has been <br /> accepted and to the best of my knowledge the foregoing oisPosAL METHOD:., ..(TOBE coMPLETED BY LANDFILL) <br /> is-true and accurate. <br /> DISPOSE : OTHER <br /> ❑SOIL <br /> EMARKS <br /> 0 CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER / ❑NON-FRIABLE <br /> ! It / 'a ASBESTOS j <br /> SIGNATURE OFAUTHOP)ZEDAGIrNT ; DATE' <br /> Ll woloD <br /> /❑ASH <br /> `�. ! J <br /> t /f .{:SPEC�A'LOT411 <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 PEM.THE DAY PRIOR T70 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 /> r " <br /> TRANSPORTER COPY , :E MANIFEST# ��� �i �0 <br />