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❑ feller Canyon ❑ Ox Mountain ❑ Newby Island Forward ,I <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill landfill <br /> 901 Bailey 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)982-421 <br /> Fax(925) 458-9891 Fax (650) 726-9183 Fax(408) 262-2871 Fax(209)982-1 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR ':._ i� x � N � `�,� c� C !+` ;.--�.x.� <br /> y WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS R ; t= , fi , f,�l6 I , Q <br /> [ \A �, <br /> a� <br /> CITY, STATE, ZIP :, �1 �_ r�*� REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE ❑GLOVES ID GOGGLES ❑ RESPIRATOR ❑HARD HAT <br /> ❑TY-VEK 0 OTHER <br /> CONTACT PERSON <br /> f SPECIAL HANDLING PROCEDURES <br /> ! SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATORS CiERTIFICAMN 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 California code of regulations has been property <br /> described classified and packaged and Is in proper condition for transportation a-cording to applicable <br /> regulations ANDS It the waste Is a treatment residue of o Previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions I certify and warrant that the waste has boon treated in RECEIVING FACILITY <br /> accordance with the requtrem®nte of 40 CFR Part 26@ and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ❑DISPOSAL R SLUDGE <br /> O CONSTRUCTION ❑WOOD <br /> ❑DEBRIS _q'0THER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> OREMM <br /> TRANSPORTER >~ ' t? A ` r,;� � � NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ryi 1^ 4 S l <br /> ADDRESSon <br /> t _ <br /> CITY, STATE, ZIP =, T„ ;tom <br /> -- <br /> PHONE[ END DUMP BOTTOM DUMP--- TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER_ DATE ROLL-OFFS FLAT-BED VAN DRUMSNIT <br /> — <br /> CUBIC YARDS r <br /> I hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing - <br /> Is true and accurate. DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> EMARKS 0 SOIL ' <br /> 9 CONSTRUCTION <br /> FACILITY TICKET NUMBER / DEBRIS <br /> ❑ NON-FRIABLE ' <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED A FNT DATE <br /> IIIIIINI <br /> r ❑WOOD <br /> ASH , <br /> �� �❑ SPIALOTHER <br /> SCHEDULINGNAUST B64ADE PRIORTO 3 00 P M.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UP0,U ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY ""'FORE <br /> l MANIFIEST# 4 <br />