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wountam_ LJ 'NOWby`island Forward <br /> SP1, Sanitary Landfill Sanitary Landfill Landfill <br /> 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> A 94565 Half Moon Bay,CA 94019 , Milpitas,CA 95035 Manteca,CA 95336 <br /> W(9Fax(925) <br /> 25)458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> -458-9891 Fax(650)726-9183 Fax(408)262.2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> r p„ . , e: t:., WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> 4' . <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE 0 GLOVES 0 GOGGLES O RESPIRATOR O HARD HAT <br /> l209's 0 TY-VEK 0 OTHER <br /> CONTACT PERSON <br /> 0 < SPECIAL HANDLING PROCEDURES: <br /> SIGNAT 0 F AVJtKM1UD 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 title 22 of the California code of regulations,has been properly <br /> destxibsd,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 as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> O DISPOSAL 0 SLUDGE AV.,(`y <br /> p CONSTRUCTION O WOOD <br /> 0 DEBRIS 0 OTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY <br /> RASPORTE NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Auumtbb <br /> Ck ,S ' <br /> -.a 4'1167 �- <br /> PHONE END DUMP BOTTOM DUMP RA E(;t <br /> S AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN UMS <br /> �� ❑ <br /> CUBIC YARDS <br /> 1 hereby,certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing <br /> is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS 0 SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATIJRE OF AUTHORIZED AGENT PATE <br /> 0 WOOD <br /> ❑ASH <br /> 0 SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULEDLOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST# 3 11 <br />