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j LJ mvirar l_.dTlyon LJ WA IVIVU1'IILd� 1 <br /> 1, U I�iGwuy-s�lart�a'•.. -as-vreeata:� - .. <br /> Sanitary Landfill 3,;S9-nitary Landfill Sanitary Landfill alndf.ill <br /> 901 Bailey Road. "'.1, SarrMateo Road 1601 Dixon L- g Road 9999 S.Austin Road <br /> Pittsburg,CA 94565 . :Haoon Bay,CA 94019 Milpitas,CA 94 Manteca,CA 95336 <br /> Phone (925)458-9800 ,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 /> I NON-HAZARDOUS WASTE MANIFEST _ <br /> GENERATOR �- WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS 2 12 <br /> t <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE ' r a; OVES O GOGGLES 0 RESPIRATOR SjiARAD HAT <br /> ❑TY-VEK ❑OTHER <br /> CONTACT PERSON SPECIAL HANDLI PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above n coed 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 property <br /> described,classified and packaged,and is in proper condition for transportation a-carding to applicable - ! <br /> regulations;AND,1fthe waste Is a treatment residue of a prevfousty restdcted 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 Part 26B and is no longer a hazardous waste as defined by - <br /> 40 CFR Part 261. _ <br /> WASTE TYPE: � -. �� - <br /> POSAL Q SLUDGE <br /> O CONSTRUCTION ❑WOOD . <br /> j. ❑DEBRIS ❑OTHER <br /> O SPECIAL WASTE <br /> i <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS. <br /> CITY,STATE,ZIP <br /> If 4 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 42 Bar) <br /> SIGNATURE OF AlTHO <br /> R Pr)A.GENTOR DRIVERS DATEL-OFFS FLATBED VAN DRUMS <br /> ❑ <br /> ❑ ❑ ❑ <br /> o, CUBIC YARDS <br /> hereby certify that the above named material has been <br /> accepted and t0 the best Of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate: <br /> DISPOSE OTHER <br /> o SOIL <br /> EMARKS <br /> 4 ❑CONSTRUCTION <br /> FACILE TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> f J ASBESTOS <br /> SIGNATWRE OFAUTHORIZED.AGENT - DATE <br /> ❑WOOD <br /> U ASH <br /> O SPECIAL OTHER <br /> . . - <br /> SCHEDULING MUST BE MADE PRIORTO 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 /> MANIFEST# <br /> � �' GENERATOR COPY 444757 � <br />