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[(eller Canyon ❑ Ox Mountain ❑ Newby Island ,, Forward <br /> ` Sanitary Landfill Mary Landfill Sanitary Mpdfill a andirm <br /> 901 Bailey Road g 1 0 San Matep.Rga d 1601 Dixon LWing Road 9999 S.Austin Road <br /> Pittsburg,CA 94565- �; Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Ph no <br /> lb 5)458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> c, Fax,(925)458-9891 :' Fax(650)726:9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> WASTE ACCEPTANCE NO. <br /> MAIL 1 G ADDRESS <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE ` �, .� U GLOVES U GOGGLES U RESPIRATOR U HARD HAT <br /> U TY VEK U OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OFAUTHORIZED AGENT/TITLE JDATE <br /> GEN TDR'S C 1 TI 1 hereby certify that the above named material Is not a hazardous <br /> w as defined by 40 CFR Part or tide 22 of the California code of regulations,has been properly <br /> described,classified and packaged,and is In proper condition for transportation a•rording to applicable <br /> regulations;AND,It the waste is•treatment residua oto pravi Dusty restricted hazardous waste <br /> subject to thelard Disposal Restrictions,I cartity 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 CFR Part 261. <br /> WASTE TYPE: <br /> O DISPOSAL U SLUDGE <br /> U CONSTRUCTION U WOOD <br /> U DEBRIS O OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY,STATE,ZIP <br /> PHONE fj ;%c END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZEP AGENT OR DRIVER DATE ROLL-0 FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> f / <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 COMPLETED BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> O SOIL <br /> REMARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> ❑ASH <br /> 11 ;1 U SPECIAL OTHER <br /> SCHEDULIN4 MUST BE MADE IORT&S:00 P.M.THE DAY PRI R O PECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL'Ill ON-ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> SALES 00PY MANIFEST# 138672 <br />