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LI •.YIIVI " V. IIIVY1114111 " IJIYII. W I VI aaYIY <br /> 'Sanitary Landfill Saary Landfill Sanitary ["fill ` Landfill <br /> 901 Bailey Road 12 San Mateo Road 1601 Dixon La g Road 9999 S.Austin Road <br /> Pidd3burg,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 WooR <br /> MAILING ADDRESS <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE <br /> „ A GLOVES O GOGGLES U RESPIRATOR J HARD HAT <br /> Its X <br /> U TY-VEK D OTHER <br /> 1CONTACTPERSON ^ l (zooSPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hareby wnity that the ebova remetl roatanal is not a nuandous <br /> waste as defined by a0 CFR Pan 261 or title 22 of the California Code of reguletbrtq,has been property <br /> downbeat,rleseified arta pruAageQ and is in proper coalition for transportation a-cording to applicable <br /> regulations;AND,N the weasa Is a trMbliant raaldua of a previously rMrkUd Mnindi waab <br /> .object to the kind Disposal ResbiClWns,I oanlFf and!.anent that the waste has been treated In RECEIVING FACILITY <br /> sono darce with he requirements of 40 CFR Pan 266 anal is no Inger a hazardous waste as defined by <br /> Q CFR Pen 261. <br /> WASTETYPE: <br /> U DISPOSAL O SLUDGE <br /> O CONSTRUCTION ❑WOOD <br /> O DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> IQ Ci 7�c Forme/ <br /> TRANSPORTER TVIt., Oil ::J�jext) suums NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS v , <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF THORIZED AGENT OR DRIVER DATE ROLL-OFF FLAT-BED VAN DRUMS <br /> ❑ ❑ <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> REMARKS U SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OFAUTHORIZED AGENT DATE <br /> U WOOD <br /> O ❑ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> LANDFILL COPY MANIFEST M 25125 <br />