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€ �-- - y u vx+,vivunza,n U Newby Island Forward <br /> t Sanitary Landfill }r =n, itary Landfill Sanitary'---lndfill Landfill <br /> 901 Bailey Road T%r�iO San Mateo Road 1601 Dixonding 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)982-4298 n <br /> Fax(925)458=9891 Fax(650) 726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOfit__ 1 <br /> WASTE ACCEPTANCE NO. <br /> MAILINQ_,ADDRES <br /> CITY`STATE,ZfP ` - ZZ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHME'- ' 't�- �� ❑GLOVES ❑GOGGLES ❑RESPIRATOR "HARD HAT <br /> U TY VEK ❑OTHER r <br /> CONTACT PERSON <br /> AA SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE f <br /> GEN9RATOR'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 a-oording to applicable <br /> regulations;AND,It the waste Is a treatment residue of a previously restricted hazardous waste J <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING AGILITY <br /> _accorda_nce with tho requirements of 40 CFR part 266 and is no longer a hazardous waste as defined 6y <br /> 40 CFR Part 261.- - ' <br /> WASTE TYPE:. f..w- - r <br /> Q DISPOSAL , V O SLUDGE <br /> Q CONSTRUCTION Q WOOD <br /> U DEBRIS ' - OTHER <br /> D SPECIAL WASTE )111 <br /> GENERATING FACILITY.;` fir. V 11-1 <br /> 1411 <br /> tDD <br /> SPOR E ! f `� /`�� NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> } Aj, I f � <br /> ESS <br /> I r <br /> CITY,STATE,ZIP <br /> PHONE-. ° v. �f� .— % _ END._DU P OM_DUMP_ .._ TRANSFER <br /> _ .i"„t..1 ,.. 4 to l — -- ❑� __BOT_T ❑ ❑ <br /> SIGNATURE-OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BI=D VAN DRUMS <br /> *� ❑ ❑ ❑ ❑ <br /> rt •' V t <br /> CUBIC YARDS <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 /> ' D SOIL ' <br /> EMARKS << ; .i <br /> � i Q CONSTRUCTION r' <br /> Ft <br /> FACILITY TICKET'NIJMBER DEBRIS�; ��;• ,�,� <br /> U NON-FRIABLE <br /> ASBESTOSr z <br /> SIGNATURE OF AUTIORIZEppAGENT, DATE , <br /> .. DWOOD gip' <br /> I _3 <br /> f,J�' f 1 I DASH <br /> ❑ SPECIAL OTHERLER <br /> �Y <br /> SCHEDULING MUST BE MADE PRIORT0 3:00 RM.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHED&ED,:LOADSARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE PA,NDFILL THE DAY BEFORE.- <br /> GENERATOR COPY - MANIFEST# <br /> 444792 <br /> I <br /> _ 4 <br />