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Sanitary Landfill Landfill - - ' ... ~-"" W <br /> Sanitary Landfill Ranitary Landfill Landfill <br /> 901 Bailey Road 28972(C"' Butte Road 12310 San Mateo Road 101 Dixon Landing Road Land9990-Sfill �n Road <br /> Pittsburg, CA 94565 Corvalli97330 Half Moon Bay, CR 94019 Milpitas, CA 95035 <br /> Phone(925) 458-9800 Phone(541) 745-2018 Phone (650)726-1819 Phone (408) 945-2800 Phone4298 <br /> o{209) 982- <br /> Fax(925)458-9891 Fax(541)745-3826 Fax (650) 726-9183 Fax (40$) 262-2871 Fax(209) 9) 982- 9 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> WASTE ACCEPTANCE NO. <br /> M ILING ADD ESS <br /> 20500 Som Holly N*vS <br /> CITY, STATE, ZIP.. REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE <br /> LX LOVES O GOGGLES ❑ RESPIRATOR ] HARD HAT <br /> CONTACT PERSON <br /> ❑TY-VEK C;SAFETY VEST <br /> A e 05ra SPECIAL HANDLING PROCEDURES: I <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> CJ <br /> GENERATOR'S CERTfFICATION:I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Pari 261 of title 22 of the Calffomia code of regulations,has been properly <br /> described,classified and packaged,and Is in proper condition for transportation according to applicable <br /> regulations:AND,If the waste Is a treatment residue of a Previously restricted hazardous waste <br /> subject to the Land Disposal Reslrfctions,I certify 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 RECEIVING FACILITY <br /> 40 CFR Part 261. _ <br /> WASTE TYPE: ...r <br /> JddISPOSAL 0 SLUDGE <br /> ❑CONSTRUCTION Q WOOD i <br /> Q DEBRIS L7 OTHER <br /> Q SPECIAL WASTE i <br /> GENERATING FACILITY ! <br /> 2050 fob betty ftivp Iil3 ACS <br /> TRANSPORTER NOTES: VEHICLE,LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> I <br /> PHO E ENS:©UMI? BOTTOM DUMP TRANSFER <br /> — <br /> 0.1 <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE R L-OFF(S) FLAT-BED VAN DRUMS ' <br /> ❑ D O ® : <br /> # <br /> CUBIC YARDS <br /> hereby certify that the aboire named material has been ` <br /> accepted and to the best of rhy-knowledge the foregoing <br /> EDISPO AL METHOD: TO BE COMPLETED BY LANDFILL <br /> s is true and accurate. ( ) <br /> DISPOSE Off.rfER <br /> i <br /> REMARKS U SOIL <br /> 0 CONSTRUCTION <br /> AGILITY TJJCK,ET NUMBER DEBRIS <br /> L]'NON-fRIABLE <br /> ,SB STOS. <br /> AT RE F AUTH AIZEC–AG IVT DATE/ <br /> t ✓ i wo D <br /> Q S ECIAL OTHER fl <br /> 1tIG MUST BE'Mr DEP IOR TO 3:00 P.M.THE DAY PRIO14 TO EXPECTED ARRIVAL•ANY UNq'dMEDULIED LOADS ARE SUBJECT <br /> L UPOt+E ARRIYJ(! 'ONGO1NG.DAILY DEILIVERIES MUST BE SCHEDULED WITH TME LANDFILL'PHE DAY BEFOAE, <br /> 024 GENERATOR COPY MANIFEST#0 <br />