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Sanitary Landfill <br />901 Bailey Road <br />',°iltsburg, CA 94565 <br />Phone (925) 456-9800 <br />Fax (925) 458-9891 <br />Landfill <br />28972 Coffin Butte -Road <br />Corvallis, OR 97330 <br />Phone&(541) 745-2018 <br />Fax (541) 745-3826 <br />Sanitary Landfill <br />12310 San Mateo Road <br />Half Moon Bay, CA 94019 <br />Phone (650) 726-1819 <br />Fax (650) 726-9183 <br />Sa& v Landflll <br />1601 b.,A-Landing Road <br />Milpitas, CA 95035 <br />Phone (408) 945-2800 <br />Fax (408) 262-2871 <br />NON -HAZARDOUS WASTE MANIFEST <br />—LandQLAt,, <br />9999 Sn <br />,CA <br />T <br />Manteca <br />Phone (209) 98 98 <br />Fax (209) 982-1 . <br />GENE TO <br />WASTE ACCEPTANCE NO. <br />7; - <br />MAILING ADDRESS797 <br />— <br />�4LO <br />CITY, STATE, ZIP <br />PHONE <br />REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br />GLOVES ❑ GOGGLES ❑ RESPIRATOR � RD HAT <br />O TY-VEK ^SAFETY VEST <br />CONTACT PERSON <br />SPECIAL HANDLING PROCEDURES: <br />- <br />_ <br />-" - - <br />SIGNATURE OF AUTHORIZED AGENT / TITLE 7DATE <br />GENERATOR'S CERTIRCATIoNtOWreby certify Net Me above named material is nes-hazardous <br />'.*safe as defined by 40 CPR Part 261 m title 22 o1 the Califomia code of regulations, has been nopody <br />ddaCffbed,,Claa died sP.d packaged, and is in proper condition for transportation acooding to applicable <br />regulatlons; AND, If the waste is a treatmiDtresldue of a prevlot sly restricted hazardous waste <br />subject to me land Disposal ResMctions, I caidly and wattanl that lhd'.jy8,5fe has been treated in <br />accordance with tine requirements of 40 CFR Pad 266 end Is m Iongera hazadous waste as defined by <br />40 CFR Pad 261. <br />RECEIVING FACILITY <br />3 "' <br />Ar <br />WASTE TYPE: <br />❑DISPOSAL - C1 SLUDGE <br />❑CONSTRUCTION - El WOOD <br />O DEBRIS - ❑ OTHER <br />- O SPECIAL WASTE <br />r <br />- <br />GENERATING FACILITY <br />TRANSPORTER. - <br />NOTES: VEEHHIICL�EE LICENSE NUMBER <br />-TR/UCICNUMBER <br />A D SS <br />S c� <br />CITY, STATE, <br />PHONE <br />END DUMP BOTTOM DUMP TRANSFER <br />was <br />❑ ❑ ❑ <br />IGNATURE OF AUTHORIZED AGENT OR DRIVER <br />DATE <br />ROLL -OFFS FLAT-BED VAN DRUMS <br />G <br />El❑ El <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 />DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br />DISPOSE OTHER <br />U SOIL <br />REMARKS <br />O CONSTRUCTION <br />DEBRIS <br />FACILITY TICKET NUMBER <br />❑ NON -FRIABLE`. <br />ASBESTOS <br />SIGNATURE OF AUTHORIZED AGENT <br />DATE <br />0 WOOD <br />9 // <br />s`.. !... t <br />0 ASH <br />O SPECIAL OTHER <br />SCHEDULING'MUST BE MAD RIOR 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 WITHTHELANDFILL THE DAY BEFORE. <br />Rev 11109 NS -024 GENERATOR COPY MANIFEST If 10070,8 <br />0,8 <br />