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--.-Y 11 L_ %,,,Uf!!fl Uutte LJlex Mountain ❑Newby Island ] Forward <br /> Sanitary Landfill Landr"' Sanitary Landfill Ianitary Landfill <br /> 901 Bailey Roar! 28972 1n Butte Road 12310 San Mateo Landfill <br /> Road —7601 Dixon Landing Road La S. Austin Road <br /> Pittsburg, CA 94565 Corvallis, OR 97330 Half Moog Bay, CA 94019 Milpitas, CA 95035 <br /> Phone (925) 458-9800 Phone (541) 745 2018 P Manteca, CA 95336 <br /> Fax (92.5) 458-9891 Phone (6�0) 726-1819 Phone (408) 945-2800 Phone (209) 982-4298 <br /> Fax (5415 745 382& Fax (650) 726-9183 Fax (408) 262-2871 Fax (209) 982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> r,, �,> k�R. .3• WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> a ., <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE XGLOVES U GOGGLES ❑ RESPIRATOR ;CI HARD HAT <br /> 7 TY VEK IaSAFETY VEST <br /> CONTACTT PERSON---'--PERSON —'-- <br /> rVrrilf, SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIrICATION,I hereby,.edify that the above named materia!is rot a hazard4llS <br /> waste as defined t;y 40 CFR Part?51 or title 22 of the California code of regulations,has been property <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 LarW Disposal Reslrictions,I certify and warrant that ttte waste has been treated in <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as ddlined by RECEIVING FACILITY <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> J DISPOSAL V J SLUDGE <br /> U CONSTRUCTION U WOOD <br /> Li DEBRIS ❑OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES: VEHICLF UCENSE NUMBER TRUCK NUMBER <br /> ,n <br /> ADDRESS <br /> CITY, STATE, ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑i ❑ — ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-01 F S) FLAT-BED VAN DRUMS <br /> r ❑ ❑ ❑ ❑ <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 true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS U SOIL <br /> U CONSTRUCTION <br /> FAC ILITY,IICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> 51GNATURC- OF AUTHORIZED AGENT — � <br /> (f LD WODtt7 <br /> t � J AS <br /> J SPECIAL OTHER <br /> SCHEDULING MIDST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS AAE SUBJECT <br /> TO REFUSAL UPON.ARRIVAL,. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> Rev 11/09 NS-024 GENERATOR COPY MANIFEST tk <br />