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L_J r.4ur,c1 v4211yur1 L-AUX Mountain U Newoy is€ana. Forward <br /> Sanitary Landfill San" Landfill Sanitary Lai Wilt Landfill <br /> 901 Bailey Road 12310 5�n Mateo Road 1601 Dixon Land, RZad 9999 S.Austin Road <br /> Pittsburg, CA 94565 Halt 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 <br /> Fax (925)458-9891 Fax(650) 726-9183 Fax(408) 262-2871 Fax(209)982-1009 <br /> <� NON-HAZARDOUS WASTE MANIFEST <br /> GENFRATOJR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESM <br /> 00 /,h < (p <br /> CITY`S ATE,ZIPJ REOUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> z iln <br /> f ` <br /> PHONE ( GLOVES 0 GOGGLES D RESPIRATOR_- . .?4iARD HAT <br /> y 0 TY VtK ' OTHER <br /> CONTACT PERSON, I <br /> SPECIAL HANDLING QROCEDU S: <br /> SIGNATQRE7 THOM ED AGENT/TITLE DATE ~' E <br /> 1;t/f <br /> GENERATORS CFJMFICAt1 f certify thal the above named matertai is rut a hazemous r <br /> waste as deAned by 40 CFR Pa 7 or tiffs 22 of the California code of reguieftra.has been Properly - <br /> desatbed,tiaastried end pedca and is in Proper condition for transportation ar=rdirg to eaWceWe <br /> regulations;AND,if the waste is a_k`aartt realdtes of a previousty raatrtaled heaardoua waifs -1l . <br /> =-subject to the land Oisposal Resuictton�a.I certffy and warrant that the waste rias been treated in - <br /> sccordanoe with the regtdnaments of Pert 268 and is no iaigar a hazwooua waste as defined by. RECEIVING FACILITY. <br /> : 10 CFR Part 261. l - <br /> WASTE TYPE: \_/A, <br /> DISPOSAL. .... O SLUDGE <br /> CONSTRUCtcQN O WOOD . <br /> -0 DEBRIS 0 OTHER <br /> --, b . <br /> O SPECIAL _ - <br /> GENERATING'�FACILIT'f. <br /> 7F/ <br /> TRANSPORT R` :' NOTES:. .VEHICLE LICENSE NUMBER " TRUCK NUMBER„ ; <br /> yj 7 . <br /> 5r. - <br /> rt <br /> CI . ,_STATE,ZIP <br /> r , =y <br /> rte„• . ;_ <br /> PHONE t END DUMP BOTTOM DUMP ...TRANSFER <br /> Q. <br /> SIGNATURE10F AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED- VAN. DRUMS <br /> :.•.. . CUBIC YARDS;::,,...--'-. w. <br /> I.hereby certity.that the above named material has-been',.' <br /> -"accepted and to the.best at.my.knowledge,theloregoing <br /> DISPOSAL METHOD:: (1.O BE COMPLETED By LANDFILL} <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> 0 SOIL <br /> REMARKS <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS . <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATUFtEOFAUTHORIZEDAGENT DATE , <br /> "0 WOOD - <br /> 0�ASiiAw r xt <br /> SCHEDULING MUST BE MADE PRIOR,. .3:D0 P.M.THE DAY:PRIORTO EXP!=CTED.ARRIVAC-ANY.UNSCHEDULEDOADS'14RE SU6:]ECT` <br /> ..... <br /> TO:REFUSAL.UPON.ARRIVAL ONGOING DAILY. DELIVERIES MUST BE SCHEDULED�WfTH THF_LANDFILL THE'DAY:BEFQRE. <br /> MAfVIFE3Yf 3 0:2.5 2= <br />