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Sanitary Landfill <br />901 Bailey Road <br />Pittsburg, CA 94565 <br />Phone (925) 458-9800 <br />Fax (925) 458-9891 <br />uLandflik. <br />WASTE ACCEPTANCE NO. <br />MAILING ADDRESS <br />Sanitary Landfill <br />Sandy Landfill <br />28972 Coffin Butte Road <br />12310 San Mateo Road <br />1601 Dixon Landing Road <br />Corvallis, OR 97330 <br />Half Moon Bay, CA 94019 <br />Milpitas, CA 95035 <br />Phone (541) 745-2018 <br />Phone (650) 726-1819 <br />Phone (408) 945-2800 <br />Fax (541) 745-3826 <br />Fax (650) 726-9183 <br />Fax (408) 252-2871 <br />NON -HAZARDOUS WASTE MANIFEST <br />u. yr vry as <br />�andfill <br />4999 S. Austin Road <br />Manteca, CA 95336 <br />Phone (209) 962-4298 <br />Fax (209) 982-1009 <br />GENERATOR <br />WASTE ACCEPTANCE NO. <br />MAILING ADDRESS <br />_ <br />CITY, STATE, ZIP <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />$71o�fc- sZ 7 <br />CLOVES"ti460GGLES (] RESPIRATOR bARD HAT <br />❑ TY-VEK �P SAFETY VEST <br />PHONE <br />17 — out <br />CONTACT PERSON <br />SPECIAL HANDLING PROCEDURES: <br />SIGNATURE OF AUTHORIZED AGENT / TITLE <br />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 ties 22 of the Calilomia code of regulators, has been propedy <br />described, classified and packaged, and is In proper condtion tar transpodato t according 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 Ne wsstehes been treated in <br />accordance with the requirements of 40 CFR Pad 268 and is no longer a hazardous waste as defined by <br />40 CFR Pad 261. - <br />RECEIVING FACILITY <br />WASTE TYPE: <br />ISPOSAL ❑ SLUDGE <br />CONSTRUCTION ❑ WOOD <br />❑ DEBRIS ❑ OTHER <br />❑ SPECIAL WASTE <br />GENERATING FACILITY <br />TRANSPORTER <br />NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br />—,5 'S <br />AD ESS - <br />t g" <br />CITY, STATE, ZIP <br />rib 4 Sl <br />END DUMP BOTTOM DUMP TRANSFER <br />G <br />❑ ❑ ❑ <br />SIGNATURE OF AUTHORIZED AGENT OR DRIVER <br />DATE <br />ROLL -OFFS FLAT-BED VAN DRUMS <br />I hereby certify that the above named material has been <br />accepted and to the best of my knowledge the to regoing <br />is true and accurate. <br />CUBIC YARDS <br />DISPOSAL METHOD: (TO BE COMPLETED BY LANDL) <br />- <br />DISPOSE OTHER <br />❑SOIL <br />y <br />REMARKS <br />❑ CONSTRUCTION <br />DEBRIS <br />FACILITY'LAUTHORIZED <br />❑ NON -FRIABLE <br />ASBESTOS <br />SIGNATUGENT TEO <br />WOOD <br />❑ A R' <br />❑ SPECIAL OTHER <br />SCHEDULING MUST BE MADE PRIOR TO 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 />Rev 11109 NS -024 GENERATOR COPY, _ MANIFEST # +.;lit h-1 l <br />