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Her,Canyon ❑ Ox Mountain ❑ Newby island Forward <br /> nitary Landfill Sanitary Landfill Sanitary Landfill " . Landfill <br /> 901 Erailey 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 /> ter,t ,-ba,�• ,,,�-�. <br /> MAILING ADDRESS <br /> fl"12n 'T!'"�•.:_4 55x3 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Ph8t_ ` ;44'1 0 GLOVES 0 GOGGLES 0 RESPIRATOR (WARD HAT <br /> „ ca. .«..a" S; f1 O TY VEK O OTHER <br /> CONTACT PERSON <br /> p . . <br /> :SPECIAL HANDLING PROCEDURES: <br /> SIG AUTHORIZED AGENT/TITLE DATE <br /> .�� <br /> GENERATOR'S CERTIFICATION:Y 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 1 <br /> described;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 /> 0 DISPOSAL O SLUDGE <br /> O CONSTRUCTION O WOOD <br /> O DEBRIS Q; HER <br /> U SPECIAL WASTE - <� <br /> GENERATING FACILITY <br /> f NSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> AD`0 nSS�.. �.: ..r�...,...:, a y. .. <br /> Cl - STA , <br /> P END DUMP BOTTOM DUMP TRANSFER <br /> S A AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT=BED VAN DRUMS <br /> C BtGA, � <br /> hereby certify that the above named material has been <br /> accepted and to the best of my knOWledge'the.foregoing DISPO METHOD: (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> O SOIL.._. <br /> REMARKS <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> 0 WOOD <br /> i <br /> 0 ASH <br /> O SPECIAL OTHER <br /> SCHEDULING MUST BE MADE'PRIORTO 3:00 P.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# <br />