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, ��Llri riw' - t r p Nearby,Island 'Landfill Sanitary Landfill° Sanitary Landfillfill <br /> t 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999S <br /> Austin Road <br /> 14t8burg,CA 94565 Half Moon Bay`,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> hone(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 r ' <br /> r WASTE ACCEPTANCE NO. <br /> MAILING ADDR S <br /> All <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> G 0 GLOVES U GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> PHONE r <br /> ❑TY VEK ❑OTHER <br /> CONTACT PERSON " SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT 1 TITLE DATE <br /> GENERATOR S CERTIFICATION I hereby certify that the above named matenaf Is not a hazardous <br /> waste as defined by 40 GFR Part 261 or bus 22 of the California code of regulations has been property <br /> described classified and packaged and is In proper condition for transponabon a^cording to applicable <br /> rsgulatwna AND,H the waste Is a trsetment residue of■previousty restrktsd hazardous waste <br /> subject to the Land Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> e�dance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> <0 CFR Part 261 <br /> MEJWASTE TYPE <br /> O DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑ OOD <br /> ❑DEBRIS ER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER - NOTES VEHICLELICENSE]NUMBER TRUCK NUMBER <br /> WTY, <br /> DDRESS STATE, ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> SIGNATURE 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 the f r to DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate <br /> DISPOSE OTHER <br /> EMARKS ❑ SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> t ❑ wooD <br /> ❑ASH <br /> ❑ SPECIAL OTHER <br /> ISCHEDULING MUST BE MADE 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 M 43680 <br />