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eller 4anyon U Ux mountain U Newby isiancl 14 Forwara <br /> apitary Landfills S ' ary!Landfill Sanitary fill Landfill <br /> `1 §Wiley Road n.r 12 San Mallq 1601 Dixon La Road 9999 S.Austin Road <br /> `burg,CA 94565. � Half Moon.Bay,`+CA4 4019 Milpitas,CA 95035 Manteca,CA 95336 <br /> ne(925)458-9800' Phone(650)7264819 Phone(408)945-2800 Phone(209)982-4298 <br /> t9 so =ax(925)41�8-9891 Fax(650)726x9183 Fax(408)262-2871 Fax(209)982-1009 <br /> teca, <br /> andFill• NON-MAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> t <br /> MAILING ADD SS <br /> a <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> U GLOVES U GOGGLES U RESPIRATOR U HARD HAT <br /> PHONE U C, '"7 • "� <br /> U TY VEK ❑OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATUR OF AUTHORIZED AG NT/TITLE DATE " <br /> �l <br /> GENERATOR'S EfiTiFICAT10N:1hareby certify that the above named material is not a <br /> waste as defined 40 CFR Part 261 or title 22 of the California code of regulations,has been prdparty <br /> deserted.Gaasified and packaged,and Is in proper condition for transportation a�rding to applicable <br /> regulations;AND,H the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the lard Disposal Restrictions,I certity and warrant that the waste has been treated in RECEIVING FACILITY <br /> scoordance with the requirements of 40 CFR Part 266 and is no larger a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> U DISPOSAL U SLUDGE <br /> U CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> / <br /> ,/ <br /> e "r <br /> TRANSPORTER ,y' NOTES: VEHICLE LICENSE NUMBER jRUCK NUMBER <br /> ADDRESS <br /> CITY,STATE,ZIP <br /> PHONE { V ? END MP BOTTOM DUMP TRANSFER <br /> SIGNATURE PF AUTHQ ED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> e ❑ ❑ ❑ ❑ <br /> / <br /> CUBIC YARDS <br /> I hereby certify that the above named material has e n <br /> accepted and to the best of my knowledge the fore 9 DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> U SOIL <br /> EMARKS <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> 0 WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY P IORTO 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 /> M/iNIFEST# 3-8673 <br /> SALES COPY <br />