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L t ncnts1 .%.,dl►,yylif U vx lvtoun[aln u i4ewDy Iisiana ILEI t-orwara <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill ' t 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 /> NON-HAZARDOUS WASTE MANIFEST <br /> 'JGWASTE ACCEPTANCE N0. <br /> rz., V. r.•:�.., <br /> nt•i eC vaa zx J%N'utt, <br /> MAILING ADDRESS _ <br /> t7ii7 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Can 's rannisrn CA 94.17.0 U GLOVES U GOGGLES U RESPIRATOR U HARD HAT <br /> PHONE <br /> c_ Q TY-VEK U OTHER <br /> CONT R O <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OFAUTHORIZED AGENT/TITLE DATE <br /> /1 Aulhorizcd Agent fm <br /> 1 f Pacific Gas ft Eltcu c ; .......-. <br /> GENERATOR'S CERTIFICATION:I hereby certify that fhe above named material is not a hazardous tYitlAt <br /> waste as defined by 40 CFR Part 261 or title 22 of the Cal;fomia code of regulations,has been property <br /> described,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> regulations;AND,if the waste is a treatment residue of a previously restricted hazardous waste <br /> .,0.fe the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requ;rements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> DISPOSAL O SLUDGE <br /> '16ONSTRUCTION O WOOD <br /> O DEBRIS ❑OTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1 ituI'it oI1 Dultyd raL(jr L tt�IFII�Il <br /> I <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> llenUeste transportation , <br /> ADDRESS <br /> CITY, STATE,ZIP <br /> -Ti Q <br /> or- CA 95492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> f7Q'7)R'-1R_1AQ7 ❑ ❑ <br /> SIGNA U OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN [DRUMS <br /> CUBIC YARDS <br /> hereby`l.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 /> 5 <br /> DISPOSE OTHER <br /> REMARKS o SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> U WOOD <br /> ? a ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL aANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br />