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„ ❑ KPIler Canyon ❑ Ox Mountain ❑ Newby Island a Forward <br /> �Sabdpry Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Half Moon Bpy,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 94,5400 <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ❑GLOVES ❑GOGGLES ❑RESPIRATOR q) -ARD HAT <br /> PHONE <br /> ❑TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> S[GNAT RE OF AUTHORIZ AGENT/TITLE DATE <br /> GENE R s CERTIFICATION I hereby certity that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the Caiifom6a code of regulations has been properly <br /> described class fred and packaged and is in proper condition for transportat en a-cording to applicable <br /> regulations AND 11 the waste is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements o1 40 GFR Part 266 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ❑DISPOSAL ❑SLUDGE <br /> 0 CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ID OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> jc'-f t -s <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBY TRUCK NUMBER <br /> ADDRESS <br /> CITY, STATE, ZIP <br /> _ I <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE/OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> / / ❑ ❑ ❑ <br /> CUBIC YARDS <br /> 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 /> [FREMARKS ' <br /> ❑ CONSTRUCTION <br /> [FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> IGNATURE OF AUTHORIZED AGENT DATE <br /> _1 wocD <br /> ❑ ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 P M 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# 35868 <br />