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�f_T., �r...� ... s .•u .r.. .w...r■.«...■ l...J iwvssroy ttaia11s41 r-meVVaIU <br /> �Sai�jary Landfill Sanitary Landfill Sanitary Landfill Rdfill <br /> 9011SA ley 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)458-9800 Phone (650) 726-1819 Phone(408) 945-2800 Phone (209) 982-429 <br /> Fax(925)458-9891 Fax(650) 726-9183 Fax(408)262-2871 Fax (209) 982-1009 <br /> - NON-HAZARDOUS WASTE MANIFEST <br /> GENERATO f - --y WASTE ACCEPTANCE NO. <br /> MAILING ADDRES i f <br /> CITY, STATE,ZIP^ , REQUIRED PERSONAE_ PROTECTIVE EQUIPMENT <br /> PHONE <br /> f �� LI GLOVES ❑GOGGLES ❑ RESPIRATOR U HARD HAT <br /> 0 TY VEK ZiOTHER <br /> CONTACT PERSON , <br /> ~ SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE i <br /> GENERATOR S CERTIFICATION l hereby certify that the above named malarial to not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the Cafifomla code of reguiawma has been properly <br /> described classified and packaged and is in proper condition for transportation a-cording to applicable <br /> regulations AND,It the waste is a treatment residue of s previously restricted 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 266 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> 0 DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION Q WOOD <br /> •DEBRISTHE3 <br /> O SPECIAL WASTE - <br /> GENERATING FACILITY <br /> � yell � �', � � - Z <br /> TRANSPORTER ' f; NOTES VEHICLE LICENSE NUMBER TRUC NUMBE <br /> ADDRESS r _1/ /f J l � <br /> CITY, STATE,ZlP_ <br /> PHONEop <br /> _ f —END DUMP _BOTPOM DUMP --TRANSFER- <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER _ DATE= _ _~ROLL-OFF S —FLAT-BE❑D= -- VAN- DRUMS- <br /> r r ❑ ❑ ❑ <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 - J <br /> is true and accurate _ DISPOSAL METHOD (TO BE Cb L EE] DFILL) u <br /> DISPOSE J OTHER <br /> REMARKS a SOIL ' <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> 0 NON-FRIABLE <br /> ASBESTOS , <br /> SIGNATURE OF AUTHORIZED AG T DATE <br /> 0 WOOD <br /> 0 ASH <br /> v l ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MAD RIORT03. P M.THE DAY PRIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVA �2NG G DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE ' <br /> GENERATORCOPY <br /> MANIFEST# - 43491 <br />