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-------- ----. --- <br />- -,�-- <br />u <br />MAILING ADDRESS <br />Sanitary Landfill <br />Landfill 1 - <br />Sanitary Landfill <br />Sank --,,y Landfill <br />Landfill <br />901 Ba81ey Road <br />28972 Coffin Butte Road <br />12310 San Mateo Road <br />1601 Dixon Landing Road <br />9999 S. Austin Road <br />Pittsburg, CA 94565 <br />Corvallis, OR 97330 <br />Half Moon Bay, CA 94019 <br />Milpitas, CA 95035 <br />Manteca, CA 95336 <br />Phone (925) 458-9800 <br />Phone (541) 745-2018 <br />Phone (650) 726-1819 <br />Phone (408) 945-28W <br />Phone (209) 982-4298 <br />Fax (925) 458-9891 <br />Fax (541) 745-3826 <br />Fax (650) 726-9183 - <br />Fax (408) 262-2871 <br />Fax (209) 982-1009 <br />NON -HAZARDOUS WASTE MANIFEST <br />GENERATOR <br />WASTE ACCEPTANCE NO. <br />MAILING ADDRESS <br />CITY, STATE, ZIP <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />5 "foe <br />Alvin '1 791 �1131 V) <br />ElGLOVES LIGOGGLES ClRESPIRATOR 1AARD HAT <br />❑ TY-VEK (/SAFETY VEST <br />PHONE <br />• <br />PSON+ <br />CONTACTER <br />SIGNATURE OF -AUTHORIZED AGENT/ TITLE DATE <br />SPECIAL HANDLING PROCEDURES: <br />GENEM60RFS C TIFICATION: I hemby certify that the above named material is not a hazardous <br />waste as defined by 40 CFR Pert 281 or UUe 22 of the California code of regulations, hea been pro <br />described, clsIfil and packaged, and Is in proper condition for transportation a=rding to applicable <br />regulations; AN9, if the waste is a treatment residue of a previously restricted hazardous waste <br />subjectto the l- d Disposal Restrictions, I cedify and warrant that the waste has been bested In <br />accordanceWith tqe requirements of 40 CFR Pad 266 and is no longer a hazardous waste as defined by <br />40 CFR Pad2 ; <br />RECEIVING FACILITY <br />- <br />WASTE TYP <br />'• jd6ISP0SAL - Cl SC GE <br />❑ CONSTRUCTION O WOOD <br />❑ DEBRIS 11 OTHER <br />❑ SPECIAL WASTE <br />f <br />GENERATING FACILITY <br />TRANSPORTER...• - <br />NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER.-- <br />ch-lil)iri; a All? IT - <br />` �y-7 - t <br />AD RESrie <br />sQ <br />CITY, STATE, IP <br />PHONE <br />END DUMP BOTTOM DUMP TRANSFER <br />❑ ❑ ❑ <br />SIGNATURE OF AUT RIZED AGENT OR DRIVER <br />-PATMel <br />OLL=OFFS FLAT-BED VAN DRUMS <br />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. <br />CUBIC YARDS <br />61SPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br />DISPOSE OTHER <br />❑ SOIL <br />REMARKS <br />❑ CONSTRUCTION <br />DEBRIS <br />FACILITY TICKET NUMBER <br />Cl NON -FRIABLE <br />ASBESTOS <br />_ <br />SIGNATURE QF ED GENT <br />DATE <br />❑ WOOD <br />l] -ASH h <br />❑ SPECIAL OTHER �. <br />SCHEDULING MUST BE MADE PRIOR Td 3-00 P.M.THE DAY PRIOR TO 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 />Revtune NA-roA GFNFRATnR l'.OPY MANIFEST# 4 n(1,74 %1 <br />