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U ��cnc1 early J1r lJ VA IVIVU111Q111 I__I IVCWUy 151d11U rvrwara <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) 982-4298 <br /> Fax(925)458-9891 Fax(650) 726-9183 Fax (408) 262-2871 Fax(209) 982-1009 <br /> 0 NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE'ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> 'VB )4 A- <br /> CITY, STATE,21P REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Masa lir ant icc n ('A 9,111?Il ❑GLOVES 0 GOGGLES ❑RESPIRATOR O HARD HAT <br /> PHONE <br /> r - - — - 0 TY-VEK O'OTHER <br /> CONT R ON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> i Q Aidbortttd Agent far <br /> ��} (/� t 1 uci6c Qrs&klectric 1 j <br /> IIT--_ _ <br /> GENERATOR'S CERTIRCATION:I hereby certify that the above named material is not a hazardous l�(U1tt' <br /> waste as defined by 40 CFR Part 261 or tido 22 of the Califonia code of regulations,has been property ! <br /> described,classified and packaged,and Is in proper condition fir transportation a-cording to apprxpbfe <br /> regulations;AND,If the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated N 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 Pad 261. <br /> WASTE TYPE: ' <br /> ADISPOSAL O SLUDGE <br /> O CONSTRUCTION O WOOD <br /> O DEBRIS O OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> �Ifurxltr)n i1+✓iryaraivai'hurnic�zt <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Ile-rWeste 3rans ortahoii / <br /> ADDRESS <br /> RFU_��Pn6�elyit, f;IT. . <br /> CITY,STATE,ZIP <br /> Windsor <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> - ❑ ❑ <br /> SIGNOF AUTH94ZEQAG NT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN D UMS <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 O SOIL <br /> O CONSTRUCTION <br /> FACILITY NUMBER DEBRIS <br /> O NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> O WOOD <br /> O ASH <br /> O SPECIAL OTHER <br /> SCHEDULING 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 />