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-aer Canyon ❑ Ox Mountain ❑ Newby Island 'EL Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Piftsburg, 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 /> Fit(925)458-9891 Fax (650)726-9183 Fax(408) 262-2871 Fax(209) 982-1009 <br /> 1 NON-HAZARDOUS WASTE MANIFEST <br /> GENERATO,i C'. ,� y'tv y WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> Lr/RE A r/ 1912, <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> �` <br /> PHONE t = GLOVES ❑GOGGLES D RESPIRATOR O HARD HAT <br /> ❑TY-VEK D OTHER <br /> CONTACT PERSON fF d ct V `T <br /> j 7. 1JVI �, S Vr� s yG SPECIAL HANDLING PROCEDURES <br /> We_SIGNATURE OF AUTHORIZED AGENT/TITLE DATE 'L. Cc�7',4,,,ti/A// I -> r," L <br /> HA <br /> AJ <br /> GENERATOR CERTIFICATION I hereby rAIfy that the above named material Is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 bf the California code at regulations has been properly <br /> described classified and packaged and la in prr condition for transportation a cording to applicable <br /> regulations AND,If the waste in <br /> a treatment r Idue of a pniviousty restricted hazardous waste <br /> subject to the Land Disposal Restrictions I cert and warrant that the waste has been treated In RECEIVING FACILITY -� ''- <br /> accordance with the requirements of 40 CFR Pa 268 and is no longer a hazardous waste as defined by W11 <br /> 40 CFR Part 261 3 <br /> WASTE TYPE It <br /> ❑DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> D DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE 0 15 n / L <br /> GENERATING FACILITY c'3 Cox <br /> x <br /> TRANSPORTER l I/t/ NOTES VEHICLE LICENSE NUMBER T U K NUMBER <br /> ADDRESS 44 V SJ <br /> CITY, STATE,ZLIF <br /> PHONE END DUMP BOTTOM DUMP TRANSFER-w <br /> d ❑ -1 <br /> SIGNATURE OFAUTHORIZED AG NT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I hereby certify that the above named material has be <br /> accepted and to the best of my knowledge the foreg ng DISPOSAL METHOD (TO BE COMPLETED BY LANDF7 <br /> ILL} <br /> Is true and accurate <br /> ,/ � <br /> DISPOSE OTHER <br /> REMARKS {/ d SOIL <br /> e ❑CONSTRUCTION <br /> FACILITY TICKET NUMB DEBRIS <br /> ❑ NON-FRIABLE <br /> Af ASBESTOS <br /> SIGNATURE OF AUT RIZED AGENT DATE <br /> ❑WOOD <br /> I ❑ASH - <br /> } ' ' ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 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 /> MANIFEST#1 5 0 4 8 5 <br /> GENERATOR DOPY <br />