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nyon ❑ Ox Mountain ❑ Newby Island Forward <br /> « unitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> pop 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landin Road <br /> Pittsburg,CA 94565 Half Moon Bay,CA,94019 Milpitas,CA anding 9999 S.Austin Road <br /> Phone(925)458-9800- Phone(650)726-1819 Phone ,CA 5035 00 Manteca,CA 95336 <br /> > Fax(925)458-9891 Fax(650)726-9183 Phone(209)982-4298 <br /> Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> TE ACCEPTANCE N0. <br /> MAILING ADDRESS WAS <br /> CITY,STATE,ZIP %J1 <br /> REQUIRED PERSONAL PR KIT <br /> PHONE O GLOVES ❑:GOGGLES 0 RESPIRATOR O HARD HAT <br /> CONTACT PERSON 0 TY-VEK O OTHER <br /> SPECIAL HANDLING PROCEDURES: <br /> SIG E OF ORIZED AGENT/TITLE DATE <br /> GENERATOR's CERTIFICATION;I hereby certify that the above named material is not a hazardous <br /> Waste as defined by'40 CFR Part 261 orfiae 22 of the California code of regulations,has been properly <br /> described,;AND,If and packaged.end n in proper condition for transportation a-.cording to applicable <br /> subjWons;AND;Ifthe waste Is ri treatment residue of a Previously restricted hazardous waste <br /> subject to the Lend Disposal Restrictions,I certify and warrant that the waste has been treated in <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by RECEIVING FACILITY <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> PISPOSAL 0 SLUDGE f <br /> CONSTRUCTION O WOOD <br /> O DEBRIS 0 OTHER <br /> O-SPECIAL WASTE <br /> GENERATING FACILITY <br /> ' ''N0TE,&,7 vEHICLfLjCENSE NUIuiBER TRUCK NUMBER <br /> a M <br /> w,x <br /> ADDRESS ' 77 <br /> r° <br /> ;rS ATE,ZIP <br /> PHON� t - <br /> END DUMP ' <br /> RbTTOM DUMP �� TRA R <br /> SCG`ATURE OF THO ED AGENT OR pFiIVER DATE <br /> ROLL-OFF S FLAT BED VAN DRUMS <br /> CI�BIC YARpSa, - <br /> 1 hereby certify that the above named material has been 4 <br /> accepted and to the best of my knowledge the foregoing ` <br /> is true and accurate. ISPOSAL METHOD: (TR BE COMPLETED BY LANDFILL) <br /> DPI POSE OTHER <br /> EMARKS <br /> NUMBER O CONSTRUCTION <br /> FACILITY TICKET <br /> .DEBRIS <br /> 0 NON-FRIABLE <br /> SIGNATURE OFAU HO ZED AGENT DATE- ASBESTOS <br /> f ®WOOD <br /> ' 0 ASH <br /> 0 SPECIAL OTHER <br /> CHEDULING MUST BE MADE PRIORTO'3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> 0 REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE, <br /> TRANSPORTER COPY MANIGFeT s s5 ft"7 <br />