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u vc■+r�rvtt U vsL IVIUu"Edl >I L NeWby.lSland Forward Sanitary Landfill Sr �.itary Landfill Sanitary P—ndfill Landfill 901 Bailey Road 14 San Mateo Road 1601 Dixon Ling Road 9999 S.Austin Road Pittsburg,CA 94565 Half Moon Bay, CA 94019 Milpitas,CA 95035 Manteca,CA 95336 ! Phone(925)458-9800 Phone(650)726-1819 Phone.(408)945-2800 Phone(209)982-4298 Fax(9 25)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 t NON-HAZARDOUS WASTE MANIFEST GENERATOR WASTE ACCEPTANCE NO. p - 2PI r !r MAILING RESS CITY„,& ATE,'ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT F ❑GLOVES 0 GOGGLES ❑RESPIRATOR U HADD HAT I ❑TY VEK CI OTHER CONTACT PERSON SPECIAL HANDLING PROCEDURES: i SIGNATURE OF.AUTHORIZED AGENT/TITLE DATE ,I f GENERATOR'S 6ERTIFICAFIDN:1 hereby certify that the above named material is not a hazardous I waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property ! described,classified and packaged,and is in proper condition for transportation a�carding to applicable A regulations;AND;It the waste Is a treatment residue of a previously restricted hazardous waste subject to the Land Dfsposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITYaccordance with the reggirements of 40 CFR Part 268 and is no Longer a hazardous waste as defined by 46 CFR Part 261 a — WASTE TYPE: •DISPOSAL E]SLUDGE •CONSTRUCTION Q WOOD -- ❑DEBRIS ^ (01'0THER ❑SPECIAL WASTE f GENERATING FACILITY: �t TRANSPOATiER tj j w NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER ADDRESS CEN,STATE 411_ u � n _. PHONE l� �_` _..__ --END HUMP =80Ti_OM_DUMP _--._... TRANSFER ❑ ❑ SIGNATURE OFAUTHORIZED AGENT OR DRIVER DATE ROL OFF S) FLAT-BED' VAN DRUMS CUBIC YARDS ” hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) is true and accurate. DISPOSE OTHER' U SOIL EMARKS ` O CONSTRUCTION FACILITY TICKET NUMBER DEBRIS_ _ ❑NON-FRIABLE -r`�- ASBESTOS SIGNATURE OF AUTHORIZE DAGENT—N DATE ❑WOOD ❑ASH i ❑SPECIAL OTHER s , SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. GENERATOR COPY MANIFEST# 444790 .