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(_J mc11c1 t.04allyull U VA 1111UU1ILdlll U IVCWuy ISldflu ,:,Wi rurwara <br /> SanitaryLLandfill 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 /> t�,..,I�,, r.. o.. <br /> �GCU n, <br /> MAILING ADDRESS <br /> iC10n— <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 4Im!Frartt'.1qc.•D CA 9412.11 0 GLOVES 0 GOGGLES O RESPIRATOR ❑HARD HAT <br /> PHONE <br /> .'r{ :%—< OTY-VEK ❑OTHER <br /> CONTAC. ERSO <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> i <br /> 4 �r1 Au$torirGd Agcut for <br /> 1 i 1 Pacific Gas&EZcrcris / .,......... <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous t`I t)Ilir <br /> waste as defined 40 CFR Part 261 or tide 22 of the California code of <br /> by regulations,has been property <br /> described,classified and packaged,and is In proper condition for transportation a-cording to applicable <br /> regulations;AND,It the waste Is a treatment residue of a previously restricted hazardous waste <br /> sub*—t to the Lard Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with ft 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 O SLUDGE <br /> D CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> 1JetWeste ransportatxon <br /> ADDRESS <br /> 1. en "!e' L...t_ -- <br /> CITY, STATE,ZIP <br /> 'QiAndsor, 95 4.92 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OFA RIZE GENZ_DR-DRfVER-- DATE ROLL-OFF(S) FLAT-BED VAN EtRUMS <br /> flid, ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> 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 /> REMARKS O SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> 0 WOOD <br /> i O ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY' RTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY <br /> /�B/E�F/ORE. <br />