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L_1yviiiin tsutie IJOX Mountain. ', <br /> Cl Newby Island {?Forward ' <br /> Sanlfiary Landfill . . 'Lt '� Sanitary Landfill 'anita.ry Landfill Lance <br /> 901 made Ftdad` 28972 n Butte Road 12310 San Mateo Road <br /> Pittsburg;CA 94565 Corvallis, OR 97330 60i Dixon Landing Road 99 Austin Road <br /> Half Moon Bay, CA 94019 Milpitas,CA 95035 Manteca, <br /> i Phone(925)45&9800 Phone (541)745-2018 Phone(650) 726-18i9 M <br /> Fax(925)458 8891 Fax(541) 745-3826' Phone (408} 945 2800 Phone,(209) 982.4298 <br /> Fax(650) 726-9183 Fax(408) 262-2871 Fax(209)'982-1009 <br /> n NON-HAZARDOUS WASTE MANIFEST <br /> f <br /> DENERATOR <br /> WASTE ACCEPTANCE NO. <br /> M ILING�ADD ESS <br /> '405M MW&H6113!Drive <br /> 990 <br /> CITY, STATE, ZIP, <br /> '±6�yeA 05304 <br /> REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHO. WGLOVES ❑ GOGGLES ❑ RESPIRATOR 1P HARD HAT <br /> C NACT PERSON Ci TY-VEK WSAFETY VEST <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby codify that <br /> the above named material is not a hazardous <br /> Waste as defined by 40 CFR Part 261 or title 22 of the Califomia 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 prevtvusly restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I codify and warrant that the waste has been treated rl. <br /> accordance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as JI,in d by RECEIVING FACILITY <br /> 40 CFR Part 264. <br /> WASTE TYPE: <br /> OSAL LJ <br /> I <br /> CONSTRUCTION ❑WOOD SLUDGE <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 20500 SQU&Ron <br /> y E)Tive TRACY ; <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER i <br /> ./1 <br /> Kim <br /> 77 <br /> C V, i <br /> PHONE I <br /> END DU BOTTOM DUMP <br /> TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> ❑ ❑ Ll Q❑ <br /> CUBIC YARDS <br /> 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 ❑ SOIL <br /> ❑ CONSTRUCTION <br /> FACILITY.TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT [?ATE ASBESTOS <br /> ❑ WOOD <br /> 2. Q ASH <br /> G SPECIAL OTHER I <br /> SCHEDULING MU ST DE MADE PRIOR TO 3.00 P.M.THE DAY PRIOR TO kXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL..:ONGOING DAILYDELIVERIES MUIST'ft SCHEDULfED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST# <br /> Rev 11109 NS-024 `[ 2 '' <br /> I <br />