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u UUM: uUX Mountain LJ Newby Island ki Forward <br /> Sanitary Landfill Landfill4.� Sanitary Landfill "`.anitary Landfill Landfill <br /> 901 Bailey Road 28972 i Butte Road 12310 Sari Mateo"Road 01 Dixon Landing Road 9999 S.Austin Road <br /> Phone rg, 5) 58-': Corvallis, OR 97330 Half Moon Bay, CA 94019 Milpitas; CA 95035 Manteca, CA 95336 <br /> Phone (925)458-5800 Phone (541)74572018 Phone (650) 726-1819 Phone"(408)945-2800 Phone (209) 982.4298 <br /> Fax (925) 458-9891 Fax(541) 745.3826 Fax(650)72&9183 Fax (408)262-2871 Fax (209) 982-1009 <br /> NON-HAZARDOUS:WASTE MANIFEST <br /> GENERATOR <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> 20500 Svc ll pF Ike — 905 <br /> CITY, STATE,'ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> .c <br /> PHONE LXGLOVES 0 GOGGLES ❑ RESPIRATOR 30 HARD HAT <br /> CON ACT PERSON © TY-VEK" CXSAFETY VEST <br /> Aaee C? SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF.AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above.named material is not a hazardous . !! <br /> waste as defined by 44 CFR Part 261 or title 22 of the California code of regulations,has been propeify <br /> described,classdled and packaged,and is in proper condition far iransportatlon according to applicable <br /> regufatlons;AND,It 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 Cl` .parPp�68 and is no longer a hazardous waste as dfined by RECEIVING FACILITY <br /> 40 CFR Part 261. <br /> WASTE TYPE: _ <br /> „.BtSPOSAL U SLUDGE <br /> Q CONSTRUCTION U WOOD <br /> U DEBRIS C3 OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 20500 gou&HQUY Elmo <br /> I <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESSlqq <br /> "� f <br /> C <br /> PHONE END DUMP BOTTOM DUMP" TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ❑ ❑ <br /> ROLL OFFS 'FLAT-BED VAN DRUMS <br /> ❑ 0 ❑ 0 <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 /> ISPO AL METHOD: (TO BE COMPLETED BY LANDFILL <br /> is true and accurate. D <br /> =r;-=> .": ) <br /> DISPOSE OTHER <br /> REMARKS 0 SOIL <br /> C] CONSTRUCTION <br /> FACILITY TICKE ..NUMBER DEBRIS <br /> Q NON-FRIABLE 1 <br /> SIGNATURE "F." THORIZED AGENT DATE-r OOD <br /> y C! si t- <br /> O"SPE IAL O r ER <br /> SCIiEDUL IWC MIJ$'f BE MADE PRIOR TO :00 F�.M.THE DAY!PRIOR"'�O BXPEOTIEO ARRIVAL.s ANY NSCHBDULED LOADS ARE SUBJECT " <br /> 'PO <br /> REFUSAL UPON A6iI�LVAL.0�1G L►IG DAILY DELIVERIES MUSS` E 11bHEDULED WITH THE LANDF LL THE DAY B>=FORE. <br /> i <br /> Rev.iiloss-o2.4 GENERATbt3 COPY `MANIFEST# <br /> } <br />