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, <br /> nyortJ 4��` p ,fix Mountain�`J ❑ Newby�,siarid ,Y u Forward d a <br /> x �� Sa�iit�ry'Lantlflll� �anitalry=Landfill Sanitary,Landfiil an iii <br /> 901"B ilPy flop ,;` 12310 San ',L <br /> ateo Road 16ftDix6n Landing Road 9999 S Austin Road <br /> Pittsburg';CA 94565 Half Moon Bay, CA 94019 Mllpitas,j 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 /> GENEAATO --- WASTE ACCEPTANCE �O.,i j <br /> MAILING ADDRES <br /> CITY, STATE, ZIP / REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> R 610 GLOVES 0 GOGGLES 0 RESPIRATOR 0 HARD HAT <br /> PHONE <br /> ❑TY-VEK ❑OTHER <br /> 3�S_IGNAZRE <br /> ONTAT PERSON/ SPECIAL HANDLING PROCEDURES <br /> OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR S CERTIFICATION I hereby certify that the above named matenai is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the Calkmia code of regulations has been properly <br /> described elassdied and packaged and is in proper condition for transportation a-Cording to applicable <br /> regulations AND,If the waste Is a treetmant residue of a prevtouafy restricted hazardous waste <br /> subject to the Land Oisposai Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFA Part 261 <br /> WASTE TYPE <br /> U DISPOSAL 0 SLUDGE <br /> ❑CONSTRUCTION 0 WOOD <br /> 0 DEBRIS ' THj R <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> RANSPORTE � _ � r NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br />' ADDRESS <br /> i <br /> CITY, STATE,ZIPS <br /> PHONE (f END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN D UMS <br /> ' ❑ ❑ ❑ ❑ <br /> 94 <br /> E I <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 DISPOSAL METHOD (TO BE MPLETED BYLANDFILL) <br />' Is true and accurate. � U <br /> DISPOSE OTHER <br /> REMARKS O SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br />' SIGNATU F.�4 ORIZ D GEN DATE ASBESTOS <br /> O WOOD <br /> ASH <br /> ❑SPECIAL OTHER <br />'SCHEDU ING MUST BE MADE PRIOR TO 3.00 P.M THE DAY PRIORTO EXPECTED ARRIVALis ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> MANI FEST# 44�9 2. <br /> - r n_tcturonTnarrwv, - � ate,. a� <br />