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'❑ fC�lier`Canyon ❑ Ox"Mountain ❑ Newby'Island rward <br /> Sanifary Landfill Sanitary Landfill Sanity Landfill �ndfill <br /> y <br /> 901 BaileRoad 12310 San ateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg, BA 94569 Halt Moon Bay, CA 94019 Milpitas,CA 95035 Manteca, CA 95336 <br /> PFtone(925) 458-9806 _ 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 { I WASTE ACCEPTANC Or%-A f 1 <br /> y 4 V <br /> MAILING ADDRESS r <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ❑GLOVES U GOGGLES O RESPIRATOR O HARD HAT <br /> PHONE <br /> ❑TY-VEK O OTHER <br /> CONTACT PERSO SPECIAL HANDLING PROCEDURES <br /> 1.SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR S CERTIRCATION I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 265 or tifla 22 of the California code of regulations has been properly <br /> described dasalfied and packaged and is in proper condition for transportation a-cording to applicable <br /> regulations AND It the waste is a treatment residue of a Previously restricted hazardous waste <br /> subiect to the Laird Disposal Restnctwm I certify and warrant that the waste has been treated in f RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and a no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> s <br /> ❑DISPOSAL O SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER / <br /> NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS , r _ --- -- A� <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOMDUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> r 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 COMP q BN FILL) <br /> Is true and accurate <br /> DISPOSE? OTHER <br /> EMARKS <br /> ❑SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHO AGENT DATE <br /> ❑wooD <br /> "� ❑ASH <br /> O SPECIAL OTHER <br /> SCHEDULING MUST BE DE PRIOR TO 3.00 P.M THE DAY PRIOR TO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE S c BEFORE <br /> MANIFEST* - 43673 J <br />