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CWtarrn-yanyon ❑ Ox Mountain ElNewby Island � Forward <br /> `Lan+dfill Sanitary Landfill Sanitary-Landfilt +` 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 /> MAILINGADDRESS <br /> 1r - r x <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PO4 <br /> -4 ``" U GLOVES O GOGGLES U RESPIRATOR U HARD HAT <br /> P ON <br /> U TYVEK U OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> S A AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is nota hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California 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 tmetment 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 281 <br /> WASTE TYPE: <br /> U DISPOSAL U SLUDGE f . <br /> UtONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> :2.023 S salu ie Rc <br /> ISPC)R?ER Y` , . § ` NOTES: trEF11LE'L' ENSE IlUMBR'° TRUCK NUMBER <br /> Oft' ZZ 77 <br /> P' END DUMP BOTTOM DUMP TRA F R <br /> Oftffhe8VAUTHOWED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I herebyertify that the above named material has.l�qaB <br /> aCCep$ed 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 /> U <br /> REMARKS SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OFAUTHOFfiZED AGENT DATEU WOOD <br /> i I i U ASH <br /> All "� <br /> 1 O SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRI ORTO 3:00 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 THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST# 372307 <br />