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Li Beller canyon ❑ (,,.,ft antain ❑ Newby lsl• <br /> Sanitary Landfill Sanitary Landfill SanitaryLandfill� �`l�oltivall <br /> 901 Saifey Road 12310 San Mateo Road Landing <br /> R Landfill <br /> Pittsburg,CA 94565 Halt Moon Bay, CA 94019 1601 Dixon Landing Road 9999 S.Austin Road <br /> Phone(925)458-9800 Phone 650)726-1819 Milpitas,CA 95035 Manteca,CA 95336 <br /> Fax(925)458-9891 Fax(6 0) 726-9183 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(408)262.2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> WASTE ACCEPTANCE NO. <br /> AYIAILING ADDRESS <br /> CITY, STATE, ZIPL ; <br /> REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE U GLOVES U GOGGLES U RESPIRATOR ❑HARD HAT <br /> U TY-VEK U OTHER <br /> CONTACT PERSON <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE SPECIAL HANDLING PROCEDURES: <br /> sF' <br /> GENikf0R'S CERTIFICAYIDN:I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Pan 267 or title 22 of the California code of regulations,has been properly <br /> descrbbed,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 restrleled hazardous waste <br /> subject to the Land Disposal Restrictions,t cartify and warrant that the waste has been trualad in <br /> accordance with the requiremaMs of 44 CFR Pan 268 and is no longer a hazardous waste as defined by RECEIVING FACILITY <br /> 40 CFR Part 261. <br /> rGENE <br /> TE TYPE: <br /> DISPOSAL Q SLUDGE <br /> CONSTRUCTION Q WOOD <br /> DEBRIS Q OTHER <br /> SPECIAL WASTE <br /> RATING FACILITY <br /> RANSPORTER NOTES: !VEHICLE LICENSE LUMBI=R �TRUC�KN�UMBER <br /> ADD SSJam. r ,.f <br /> CITY,STATE,ZIP - ` <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OFAU ORIZED AGENT OR DRIVER DATE ROLLt-O F S} FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing <br /> is true and accurate. 4 DISPOSALMETHOD:tOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> Q SOIL <br /> REMARKS j t <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OFAUTHORIZED.AGENT 4 DATE <br /> Q WOOD <br /> 0 ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SU13JECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST-BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. . <br /> MANIFEST N ar `? <br /> GL.:'NER,'1I_0R <br />