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eller Canyon F1 Ox Mountain E] Newby Island [ Forward <br /> 0` <br /> ,Sahitary Lindflll Sanitary Landfill Sanitary Landfill Landfill <br /> � 901 Batley 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 /> r , <br /> MAILING ADDRESS 945400 <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ' Q PLOVES ❑GOGGLES ❑ RESPIRATOR OtitiARD HAT <br /> PHONE <br /> ❑TY VEK ❑OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE,,OF AUTHORIZED/AGENT/TITLE DATE <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material rs not a hazardous <br /> waste as defined by 40 CFR Part 251 or title 22 of the Caldernia code of regulatlo'ts has beer properly <br /> described classified and packaged and is in proper condition for transportation a-cording tc applicable <br /> regulations AND If the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restnctions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requtfemenls of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Pan 261 <br /> WASTE TYPE <br /> ❑DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY <br /> MOM <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OFAUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> f <br /> CUBIC YARDS _ <br /> t <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 /> SOIL <br /> REMARKS <br /> ❑ CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> 0 ASH <br /> _ t <br /> D SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORT0 3 00 PM 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 /> SALES COF� MANIFEST# 5 8 5 6 <br />