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LI ncnct vatryuli .Lt UA I1fluullld111 Lj fvewuy isianu vj rorwara <br /> SanitaryLandfill 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 /> ` NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> u t c +.7 x �: e <br /> tIMAILING ADDRESS <br /> innrl— <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San C�rA ()41?0 ❑GLOVES 0 GOGGLES O RESPIRATOR 0 HARD HAT <br /> PHONE <br /> ❑TY-VEK ❑OTHER <br /> CON O1V <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGN A` HORI EDs1AGENT/TITLE DATE <br /> ,, <br /> �^zrd Age-at ctr <br /> i_ &Electric <br /> - r <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous 1`IUdaL <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regutabons,has been property <br /> described,classified and packaged,and is in proper condition for transportation a-carding to applicable <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 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 /> ISPOSAL 0 SLUDGE <br /> C1 bONSTRUCTION 0 WOOD <br /> 0 DEBRIS o OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> 3'lh=tun Dohydratur i hnn«4cn� <br /> TRANSPORTER NOTES: VEHIPLE LICENSE NUMBERT TRUCK NUMBER <br /> rl,enBeAQ rransortauon <br /> ADDRESS <br /> 820_enHt'cto C_ <br /> CITY,STATE,ZIP <br /> Windgor <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 17A 13 Q a <br /> SIGN AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepte 'nd to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> y is true and accurate. <br /> DISPOSE OTHER <br /> REMARKS O SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET 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 a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> -- -- ......�.._.. n A4 nn4 <br />