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y Island Forward <br /> G7, KpIler Canyon ❑ Ox Mountain SaniNewtary Landfill Landfill <br /> Sanitary Landfill Sanitary Landfill y 9999 S Austin Road <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road <br /> Half Moon Ba CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Pittsburg,CA 94565 y' Phone (408)945-2800 Phone (209)982-4298 <br /> phone (925)458-9800 Phone (650)726-1819 Fax (408) 262-2871 Fax (209) 982-1009 <br /> • Fax (925)458-9891 Fax (650)726-9183 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> I <br /> MAILING ADDRESS 9 4 54 00 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ❑-GLOVES U GOGGLES ❑ RESPIRATOR 0-HARD HAT <br /> PHONE <br /> U TY-VEIC tU OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZEAGENT/TITLE DATE <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material,s not a haza dour <br /> wasteas defined by 40 CFR Part 261 or tale 22 of the California code of regulations has been properly <br /> described classified and packaged and is in proper condilion for transportation a^cording to app6cabhe <br /> regulations AND It the waste is a treatment residue of a previously restricted hazardous waste RECEIVING FACILITY <br /> subject to the Land Disposal Restrictions i cenity and warrant that the waste has been treated In <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> 0 DISPOSAL U SLUDGE <br /> 0 CONSTRUCTION U WOOD <br /> U DEBRIS 7 OTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY <br /> Ell=I <br /> NOTES VEHICLE LICENSE NUMBER {TRUCK NUMBER <br /> TRANSPORTER <br /> ADDRESS <br /> CITY, STATE, ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ `� <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> DC2 <br /> SIMI <br /> CUBIC YARDS <br /> 1 hereby certify that the above named materia{ has been <br /> accepted and to the best of my knowledge the foregoing DISPOSAL IVETHGD (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate <br /> DISPOSE OTHER <br /> U SOIL - <br /> REMARKS U CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER U NON FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE 0 WOOD <br /> 0 ASH <br /> _ SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 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 /> SP LES COPY MANIFEST Of .) 0857 <br />