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0a yon LJOx Mountain ElNewby Island [ Forward <br /> nitary Landfill Sanitary Landfill Sanitary tandfIII' Landfill <br /> X901 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 1 <br /> � a 5 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> O GLOVES O GOGGLES O RESPIRATOR O HARD HAT <br /> PO ..E .. _ <br /> '>U4 ' 4 -° ,"4 O TY VEK O OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> S A AU ED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I herebycertiy that the above named material is not a hazardous <br /> waste as definetl by 40 CFR Part,261 w tide 22 of the California oode of regulations,has been properly <br /> described,classified and packaged,and is inpr�er condition for transportation a cording to applicable <br /> regulations;ANO ft the waste Is a treatmoM residue of a prevbusly resUictad hazardous waste <br /> subject to the Land Disposal Restrictions,I certify aril 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 /> O DISPOSAL O SLUDGE <br /> UCONSTRUCTION O WOOD <br /> O DEBRIS O OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> <,. <br /> 4;Sf s.w z'a4.u.s..'3.,. <br /> TRANSPORTER NOTES: VEHICLE I ICENSE NUMBER TRUCK NUMBER <br /> ADDRESS A Ud) 11,77g <br /> P TA <br /> P END DUMP BOTTOM DUMP TRANSFER <br /> AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> /hereby certify that the above named material 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 /> 111111111111111REMARKS O SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> S AT F AUTHORIZED AGENT DATE <br /> �., O WOOD <br /> O ASH <br /> '--' O SPECIAL OTHER <br /> SCHEDULING MUST BE E PRIORTO 3:00 P.M. DAY PRIORTO EXPECTED ARRIVAL a 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# 372312 <br />