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u Icelier canyon U Opt MountalW ❑ Newby Island RfForward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br />' 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Haff Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925)4558-9800 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 <br /> NON-HAZARDOUS WASTE MANIFEST <br />' GENERATORIli. <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS L} Q f 9 <br />' CITY, STATE,ZIPf <br /> REQUIRED PERSONAL PROTECTI E EQUIPMENT <br /> PHONE ❑GLOVES D GOGGLES ❑RIrSPIRA OR MARC)HAT <br />' 0 TY VEK D OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES 1 <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE HARD HAT R E aV I R E D h T LA IT <br /> 'ILL <br /> 19 a <br /> GENERAT R S CERTIFICATI I hereby that the above mmed materia!Is not a hazardous <br /> waste as de* by 40 CFR P 261 or tltte 22 of the C Dorm coda d rapulskma,has been property <br /> and Is In pr*pw oordbon for <br /> regutaporrs AN4 ti w sal al tresunord ue prrria+ nMitricted irwrnidow <br /> subject to me Land pnpoasl RRsatrlUlona !teray and warts=that the walla has been treated to apwpakmaeblem <br /> 4D <br /> a0cordarce d the rewnwtenq of 4D CFR Pan 2W and is no bnger a hazardous waste as dAwd by RECEIVING FACILITY261 <br /> r <br /> WASTE TYPE <br /> DISPOSAL U SLUDGE <br /> CONSTRUCTION ❑WOOD <br /> Q QEBRIS O OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> i$io t. NAztLJOR AVE. <br /> RANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br />' ADDRESS <br /> CITY,STATE,ZIP <br />' PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) -BED AN DRUM <br /> 7/0 14 <br />' CUBIC YARDS <br /> i hereby certify that,the above named material has been _ 4 <br /> accepted and to the best of my knowledge the foregoing DISPOSAL M D (TO BE COMPLeftD BY LANDFILL) <br /> 11 <br />' is true and accurate. <br /> DISPOSE AA OTHER <br /> REMARKS D SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> O ASH <br /> �Ic �s ( <br /> D SPECIAL OTHER <br />'SCHEDULING MUST BE MADE PRIORTD 3 00 P-M.THE DAY PRIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED OiADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFIL THE DAY BEFORE <br /> MANIFEST 54125 <br /> n_cuco arno rnov <br />