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;I VX_Mountaln }< NBwby <br /> rr4 , L1 , stand - <br /> rSanitary Landfill Sanitary L�dfIll - Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Matea Road 1601 Dixon Landing 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 <br /> ' Fax(925)458-9891 Fax (650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS �, 4 <br /> CITY, STATE, ZIP f—=s ( 1 t;71 REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE d GLOVES ❑GOGGLES U RESPIRATOR U HARD HAT <br /> O TY VEK U OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material Is not a hazardous <br /> waste as defined by 4o CFR Part 261 or title 22 of the California code of regulations has been property <br /> described ciassified and packaged and is in proper condition for lransportaton a-cording to applicable <br /> regulatlons ANp,If the waste Is a treatment residue of a prswouw restricted hazardous waste <br /> sum dar CO withthe thethe nd regwirements of 0 CFR Pan 268 and tnctlons I certify and no longer the waste has been waste <br /> treated in RECEIVING FACILITY <br /> 40 CFR Part 264 onger a hazardous waste as defined by <br />' WASTE TYPE <br /> ©DISPOSAL U SLUDGE <br /> U CONSTRUCTION U WOOD <br /> U DEBRIS NROTHER <br /> *SPECIAL WASTE <br /> GENERATING FACILITY <br /> rte\ <br /> RANSPORTER I NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS "� ` [�#r to <br /> CITY, STATE, ZIP '�[j �-�-p —, <br /> PHONE q END DUMP BOTTOM DUMP TRANSFER <br /> 51GNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL OFFS 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 he foregoing DISPOSAL METHOD <br /> Is true and accurate. (TO BE COMPLETED BY LANDFILL) <br /> �v1 DISPOSE OTHER <br /> EMARKS O SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBERDEBRIS <br /> r <br /> U NON-FRIABLE <br /> SIGNATUF AUTHORIZED AGE T DATE ASBESTOS <br /> RE O <br /> U WOOD <br /> z <br /> U ASH <br /> 7fP <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3.00 P.M THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br />�O REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> MANIFEST#t - 43683 <br /> � - n_c►rrwni►Tnnrnov e > _ <br />