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U Keiier%;any®n LJ VA erevu®tacaaea u "--"—s <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 <br /> Half Moon Bay,-CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(650)726-1819 <br /> Phone(925)458-9800 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 <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> CITY,,STATE,ZIP P <br /> O GLOVES O GOGGLES O RESPIRATOR O HARD HAT <br /> P ON <br /> O TY VEK O OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> Sil AUTHORIZED AGENT/TITLE DATE / <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is rot a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the Catlfomia ode of regulations,has P 8 <br /> dassiffied grid ,and is in proper cor ition for tram s to n <br /> regulations;AND,n the Taste Is a trsatrtteat residue of a Previously restricted hazardous wast- RECEIVING FACILITY <br /> stMect to the lard Disposal Restrictions,i cer*and warrant that the waste has been trued in <br /> accordance with the requirements of 40 CFR Part 268 and is no tomer a hazardous waste as defined by <br /> 40 CFR Part 281. <br /> WASTE TYPE: <br /> O DISPOSAL O SLUDGE <br /> UtONSTRUCTiON O WOOD <br /> O DEBRIS O OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> „NSP <br /> ' qR KNUO : <br /> ORTER ViHICLE <br /> tiABEI <br /> A r_ - <br /> a <br /> drR,'ST <br /> P46" END DUMP BOTTOM DUMP TRA F R <br /> S r R LITHOD AGENT OR DRIVER DATE ROLL-OFFS FLAT BED VAN DRUMS <br /> f <br /> I'm Jill <br /> CUBIC YARDS <br /> 1 hereby rtify that the above named material has been <br /> accepteI and to the best of my knowledge the foregoing DISPOSAL METHOD: (t0 BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> O SOIL <br /> EMARKS O CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHOPIAZED AGENT DATE,,,' O WOOD <br /> O ASH <br /> ► i ° ' ®SPECIAL OTHER <br /> v , <br /> SCHEDULING MUST BE MADE PRIORTO3:00 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 N �THE DOAY BBE RE- <br />