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Saniltary Landfill Lal)dfill Sai itary Landfill Sanitary Landfill L'aI10J( <br /> 901 Bailey Road 28972 Co utte Road 12310 San Mateo Road Uixon Landing Road 9999 S. 'U,-iii,1�rrVl <br /> Pittsburg, CA 94565 Corvatlis, u~"'97330 Haff Moon Bay, CA 94019 t-..etas, CA 95035 Mnnle-..,. : P5326 <br /> Phone (925) 458-9800 1 (541) 745-2018 Phone (650) 726.1819 Phone (408) 945-2800 Flurli <br /> Fax (925) 458-9891 Fax (541)745-3826 Fax(650) 726-9183 Fax (408) 262-2871 Ptl;:(2101) )r.:._-I:'A_l <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE — <br /> C1`GLOVES U GOGGLES U RESFIF3ATUI <br /> PHONE <br /> 0) 834- ,'r,) ❑TY-VEK C, SAFETY VEST <br /> CONTACT PERSON ---___ -_.! <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE: OF AUTHORIZED AGENT/TITLE DATE <br /> 444 <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has bean properly <br /> described,ciassilled and packaged,and is in proper condition for transportation according to appiicable <br /> i <br /> regulalicns:AND,ti the waste is a treatment residue of a prevlousfy restricted hazardous waste <br /> subject to file Land osposal Restrictions,f certify and warrant thal the waste has been treated In RECEIVING FACILITY - <br /> accordance will I the requirements of P C;FP Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Pad 261, <br /> WASTE TYPE: `::7 - <br /> abISPOSAL U SLUDGE ------— <br /> U CONSTRUCTION CI WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE - -- - - - <br /> GENERATING FACILITY _._... <br /> '7— <br /> TRANSPORTER <br /> 7 -TRANSPORTER NOTES: VEHICLE LICENSE NUMBER THUCK ! f3 <br /> °;�A <br /> ADDRESS ti_I f. ,• I+ <br /> CITY, STATE, ZIP <br /> PHONE - END DUMP BOTTOM DUMP 'I I f'13"`"FFR <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S_ FLAT-BED VAH J� I)FIili"ilS � <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been �• <br /> accepted and to the best of my knowledge the foregoing ------- <br /> is <br /> ----- ----is true and accurate. DISPOSAL METHOD: (TO HE COMPLETED 3Y Lfi,i lI>FiLI_} <br /> DISPOSE <br /> REMARKS U SOIL ---- <br /> U CONSTHUCTION _ ^ <br /> FACILITY TICKET NUMBER DEBRIS - _ <br /> J NQN-FRIABLE <br /> i ASBESTOS <br /> SIGNATURE OP AUTHOnIZED AGENT DATA; <br /> U WOOD <br /> J ISH <br /> Q ISPECIAL OTHEP <br /> a• ,,-a. <br /> SCHEDULING MUST BE MADE, 1 ion TO 3:00 EP.M.THE DAY PRIOR TO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TA REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> 1 11/09 NS-024 GENERATOR COPY MANIFEST 9 s;;t. t <br />