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Canyon ❑ Ox Mountain F1Newby Island Forward <br /> PORanl4tary 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 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 /> MAILING ADDRESS <br /> ,r dW.-'y . 7,;s <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> P O S U GLOVES U GOGGLES O RESPIRATOR U HARD HAT <br /> O TY VEK U OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> S AR NMI=AUTHORIZED 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 or Ude 22 of the Calffomia code of regulations,has been properly <br /> described,classified and packaged,and is in proper condition for transportation a-.cording to applicable <br /> regulations;AND,M the waste is a treatment 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 261. <br /> WASTE TYPE: <br /> O DISPOSAL O SLUDGE .�. <br /> Q CONSTRUCTION U WOOD <br /> O DEBRIS U OTHER <br /> ®SPECIAL WASTE <br /> aENERATING FACILITY <br /> ORRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> 112 <br /> .CrrY,'STATE,' <br /> P END DUMP BOTTOM DUMP TRANSFER <br /> S UTHOR D AGENT OR'DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> Ir ❑Y /_/I (-/*I- <br /> ❑ ❑ ❑ <br /> CUBIC YARDS <br /> I hereby certify that the above named materia! 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 /> U SOIL <br /> EMARKS <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBERDEBRIS <br /> o U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATF'' TH ,IZE AGENT —, DATE <br /> U WOOD <br /> UA <br /> SH <br /> 1 <br /> 711' / U SPECIAL OTHER <br /> SCHEDULING MUS lfMADE PRIORTO 3:06P.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# 179110 <br />