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❑ Xelier Canyon ❑ Ox Mountain ❑ Newby Island ❑ Forward <br /> Sanfltdr� Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Barley Road 12310 San Mateo 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)458-9600 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)962-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR . WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> '---Y E _r i�a� C`', µs'[,'�"'+ R ' s t'.. i'✓ .... �--tai i' ''.. <br /> CITY, STATE,ZIP REQUIRED PERSONAL. PROTECTIVE EQUIPMENT <br /> U GLOVES Q GOGGLES ❑RESPIRATOR U HARD HAT <br /> PHONE <br /> ❑TY VEK U OTHER <br /> CONTACT PERSON, ! SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT l TITLE DATE <br /> 3 � <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the Caidomia code of regulations has been properly <br /> dm MriMA .ciss..-cmeA.s ..�. .-A ec-d I n -a-cc.d-g Iz u ni_ible <br /> �r�...�.-i� u �r"r � w <br /> regulations AND If the waste Ys a treatment residua of a prervioueiy restricted hazardous waste <br /> subject to the Land Disposal Restrictions t certify and warrant that the waste has been treated In RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Pad 266 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ❑DtSPOSAL Q SLUDGE <br /> JQ CONSTRUCTION Q WOOD <br /> U DEBRIS Q�THER <br /> Q SPECIAL WASTE <br /> �GEFNERATINGFACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> 1, <br /> ADDRESS n <br /> CITY, STATE,ZIP ` <br /> PHONE-'_qr kI t id END DUMP BOTTOM DUMP TRANSFER <br /> 71111111 Q U El <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> hereby certify that the abode named material has been <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate <br /> DISPOSE OTHER <br /> EW S ❑ SOIL <br /> ❑ CONSTRUCTION <br /> IFACILITY TICKET NUMBER DEBRIS _ <br /> O NON-FRIABLE: <br /> ASBESTOS <br /> IGNATUREeOF AUTHQRIZED AGENT DATE <br /> f 4 r <br /> ❑WOOD <br /> Q ASH <br /> Q SPECIAL OTHER <br /> ISCHEDUL JNG MUST BE dAQ_E 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 # 43482 <br />