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ernyon � El Newby Island Forward <br /> Sanita :III d dill Sanitary Landfill Landfill <br /> Bailey Ro s;l <br /> 2'i' <br /> 901 �- ,�; �.t i ad 1601 Dixon Landing Road 9999 S:Austin Road <br /> Pittsburg,CA 94565 1(a4 zt,, 9""7119 Milpitas,CA 95035Manteca,CA 95336 <br /> Phone(925)458-9800 Ph6,ne :,a; fi126=181`' 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-HAZAR6066 WASTE MANIFESTIIIIIIII <br /> GENERATOR WASTE AftEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY,STATE,ZIP RE {IRED PERSONAL PROTECTIVrEOUIPMENT <br /> PHONE ❑GtOVES 0 GOGGLES ❑RESPIRATOR ` U HARD HAT <br /> ,. ' ,!a. . Q'TY VEK ❑OT <br /> CONTACT PERSON <br /> :SPECIAL HANDLING PROCEDURES: <br /> S1IG ATURE AUTH RIZED AGENT/TITLE DATE & <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous t <br /> W <br /> aste as defined by 40 CFR Part 261 or fills 22 of the California code of regulations,has been properly <br /> dssod,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> regulations;AND,if 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 a$defined by <br /> 40 CFR Part 261, <br /> WASTE TYPE: <br /> •DISPOSAL' •SLUDGE '"� � <br /> U CONSTRUCTION U WOOD <br /> O DEBRIS ❑OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> A&M _ s <br /> S �� <br /> PHONE END DUMP BOTTOM DUMP N F <br /> S AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN S <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 /> REMARKS O SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> NON-FRIABLE <br /> SIGNA RE OF HORIZEDAGENT DA ASBESTOS <br /> UWQOD <br /> fU ASH <br /> f ` U,SPECIALOTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.MTHE 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# <br />