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44�ceper canyon u ox,Mountain ❑ Newby Island- Forward <br /> ,� an'tary Landfill S ary Landfill Sanitary fill ndfili <br /> 901 alley Road a 1 San Mate -�41d 1601 Dixon La Road 9999 S.Austin Road <br /> P'� ufg,CA 94565. Half Moon Bay, A 94019 Milpitas,CA 95035 Manteca,GA 95336 <br /> Phond?(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 `WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS 2 ds •' C';'t _ <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE U GLOVES U GOGGLES O RESPIRATOR U HARD HAT <br /> ❑TY VEK U OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S COMFICAnoN: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 /> descr bed,classified and packaged,and is in proper condition for transportation a^cording to applicable <br /> regulations;AND,h the waste is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I cartify and warrant that the waste has been treated in RECEIVING FACILITY <br /> 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 /> ❑DISPOSAL ❑SLUDGE <br /> a CONSTRUCTION 0 WOOD <br /> O DEBRIS O OTHER <br /> •SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES: VE LICENSE VUMBER I T K NUMBER <br /> ADDRESS 7—/7-4/2— A 041 e-41r <br /> CITY,STATE,ZIP <br /> iiiiiiiiiiiPHONE END PUMP BOTTOM DUMP TRANSFER <br /> ❑ <br /> SIGNATURE OF AUTHORI 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 foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> EMARKS ®SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> SIGNATURE OF THORIZ D AGENT DATE ASBESTOS <br /> / r <br /> 0 WOOD <br /> �. ASH <br /> O SPECIAL OTHER <br /> HEDULING MUST BE'MADE PRI RTO 3:00 P.M� DAY PRIOR, O PECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> REFUSAL UPON ARRIVAL. ONGOING DICILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> SALES COPY MANIFEST# 1.38674 <br />