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rtyor: `y ❑ Ox Mountain ❑ Newby Island <br /> Q Forward <br /> I alr� andfill Sanitary Landfill Sanitary'Landfill Landfill <br /> 901 Bailey Riad 12310 San Mateo Road 1,601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay, CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone X92;3)458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> F (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 /> MAILING ADDRESS <br /> CITY,STATE,ZIP REQUIRED.PERSONAL PROTECTIVE:EQUIPMENT <br /> s ° ' s " t; Q GLOVES Q GOGGLES Q RESPIRATOR Q HARD HAT <br /> PHONE <br /> it t , f :3v Q TY-VEK Q OTHER <br /> CONTACT PERSON <br /> I; . .1-1 i j SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOAt CERTIFICATION:I hereby,certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or dde,22 of the California code of regulations,has been properly <br /> nbed,classified and packaged,and is improper condition for transportation axording to applicable <br /> regulations;AND,M On wage is a treatment tesl6ue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I certify and warrantthe,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 Par(281. <br /> WASTE TYPE: <br /> Cl DJ,SPOSAL ❑SLUDGE � ) �; L vy4 <br /> O'CONSTRUCTION O WOOD <br /> Q DEBRIS U OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> ... <br /> Qtl'ER <br /> NOTES:' VEHICLE LICENSE NUMBER TRUC, 'NU ER' <br /> ADDRESS � `•--�'' <br /> C �STAE Z41#P <br /> M B = DUMP— TRAS ER <br /> SI NA AUTHORIZED AGENT OR'DRIVER DATE ROLL'-OFF FLAT BED VAN <br /> or <br /> �UB"IQ YARDS <br /> hereby certify that the above named material has been <br /> accepted and to the best of my knOWledge the foregoing DISPOSAL METHOD: (TOB GOMPL�ET D BY LANDFILL) <br /> Is true and accurate. _N <br /> r <br /> DSP E OTHER <br /> REMARKS © OIL <br /> U CONSfhUCTION' <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNA ,RE OF AUTHO ED AGENT DATE",- <br /> U:WOOD <br /> O ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIOR TO 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 /> TRANSPORTER COPY MANIFEST# 372308 <br />