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_ •r wrl "%OW1tfrt,uae LUX.MOuntain LJ Newby Island I�JForwards- <br /> Sanitary Landfill Landf, Sanitary Landfill anitary Landfill Landfill <br /> 901 Bailey Road 28972 i gutta Road 12310 San Mateo Road 01 Dixon Landing Road 9999 S. Austin Road <br /> Pittsburg, CA 94565 Corvallis, OR 97330 Half Moon Bay, CA 940' 9 Milpitas, CA 95035 Manteca,CAL-95336 <br /> Phone(925) 458-9800 Phone (541) 745-2018 Phone(650) 726-1.819 Phone (408)945.2800 Phone (209)982-4298. <br /> Fax(925) 458-9691 Fax(541) 745-3826 Fax(650) 726.9193 Fax(40B) 262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> WASTE ACCEPTANCE N®: <br /> MAILING ADDRESS <br /> 94-905 <br /> CITY, STATE, ZIP: REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE CXGLOVES ❑ GOGGLES © RESPIRATOR M HARD HAT <br /> CONTACT PERSON ©TY-VEK IXSAFETY VEST <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above earned material Is not a hazardous <br /> waste as defined by 40 CFH Part 261 or title 22 of the California 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 Restrictions,I certify and warrant that the waste has been treated in <br /> accordance with the requirements of 40 CFR Part 266 and Is no longer a hazardous waste as dojined by RECEIVING FACILITY <br /> 40 CFR Part 261, <br /> WASTE TYPE: <br /> U DISPOSAL U SLUDGE i <br /> U CONSTRUCTION U WOOD <br /> O DEBRIe U OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 2415M Som Hog;,1� TFLA.CY <br /> .r i <br /> TRANSPORTER NOTES: VEHICLE LIGENSE NUMBER TRUCK NUMBER <br /> ADDRESS10 Ir '- <br /> ,. <br /> CITY, S A <br /> PHONE END DUMP BOTTOM DUMP TRANSFER . <br /> 7 ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLK- FF S FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑`. ; <br /> f <br /> CUBIC YARDS <br /> hereby certify that the above reamed 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 /> I <br /> REMARKS R SOIL <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> LJ NON-FRIABLE <br /> SIGNATURE OF AL)THORIZED AGENT DATE ASBESTOS <br /> }+ 'J WOOD <br /> r .r' U ASFi <br /> . <br /> - <br /> :;IAL:',OTHER. <br /> SGNELy1fLINQi MIDST BE IYIADE RRIORTO 3 00 P l4�THE DAY IPRIOR TO Il(iPIEC�IED AR�iIYAI.�:ANY UNSCkIrC13f}E{1 .OADS'�IIRE SUII�.IC� <br /> ' ?O R�FUSALi1PON'ARRIVAL ONGOING pA14.Y DSL1{�IERIES INI�S`r�E'�vCiiE�U1]�D�V�I!1'1<`IFl��IE`C:hi�1DF�L��.T11� ,11Y,�LrFDR1; :: <br /> x .`.Revs 11109 NS-024� , , �� ;�� �s ti,�1�, CCI[�fER�TC� ;COPY.'af :..��' �':,�7��,����� `,`-��'_➢�j�tNl';F`f�`,�* �``" w4.� �` <br /> r'�LiY!:te � 5.�a a <br />