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--ailliary Eananq Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 28972 G Butte Roar! 12310 San Mateo Road _ <br /> Pittsburg, CA 94565 Corvalli F j 97330 Half Moon Bay, CA 94019 .' ltas, CA 9503158 Road Mang ca, CAS. 19 336 <br /> Phone (925) 458-98()o Phone (541)745-2018 Phone (650) 726-1819 h 0 (408) 945-2800 <br /> Fax(925) 458.9891 Fax(541) 745-3826 Fax (650)726-9183 Phone 2 <br /> Fax(408) 262-2871 Fax(2 9)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> 'fl3' <br /> GENERATOR <br /> WASTE ACCEPTANCE NO. <br /> M ILING ADD ESS <br /> 911905 <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONEUGLOVES J GOGGLES ❑ RESPIRATOR M HARD HAT <br /> f ❑TY-VEK CXSAFETY VEST <br /> C N ACT PERSON <br /> . e Ovey SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERA'TOR'S CERTIFICATION;I hereby certify that the above named material is not a hazarcicus <br /> waste as defined by 40 CFR Part 261 or title 22 of the CaVomia code of regulations,has been properly - <br /> described,classified and packaged,and is in proper condition for transportationtioaccordinto applicable waste <br /> regulations;AND,If the waste is a treatment g ent residue of a previously restricted hazardous w <br /> subject to the Land Disposal Restrictions,I certify end warrant that the waste has been treated <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous.wasto as defined by RECEIVING FACILITY <br /> 40 CFR Part 261. <br /> WASTE TYPE: . <br /> ❑DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> 0 DEBRIS ❑OTHER <br /> D SPECIAL WASTE <br /> GENERATING FACILITY <br /> 20500 Sow&Hre ft�rtw TRACY <br /> TRANSPORTER r' NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY, STATE, ZIP <br /> r <br /> PHONE END DUMP BOTTOM DUMP TRANSFER I <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE 0 1 <br /> ROk -OFF(S) FLAT-BED VAN DRUMS <br /> © o o <br /> r <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> acgepted 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 /> ❑ <br /> REMARKS SOIL ,. 1 <br /> ' ❑.CONSTRUCTION i <br /> FACILITY/ ICKET NUMBER DEBRIS <br /> } 't C1 NON-FRIABLE <br /> SIGNA-11! RI$�OF AUTHORIZED AGENTSATE ASBESTOS <br /> f € # ❑ WOOD <br /> ❑ ASH <br /> f V ❑ SPECIAL OTHER <br /> SCHDULIN MUST REMADE PRION TO 3:00 P.M.THIE DAY PRIOR TO EXPECTED ARRIVAL.ANY UNSCHEDULED LOADS ARE SUBJECT:' . <br /> YO RI£FUSAL UPON ARRIVAL.ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILLTHE DAY O <br /> � BEFRE. <br /> I <br /> flay 11/09 NS-024 <br /> GENERATOR COPY MANIFEST# <br />