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�ou«e Uvx Mountain LJ Newby Island t J Forward <br /> Sanitary Landfill Land It Sanitary Landfill "'anitary Landfill Landfill <br /> 901 Batley Road 28972 h Butte Road 12310 San Mateo Road x401 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg, CA 94565 Corvallis, OR 97330 Half Moon Bay, CA 94019 Milpitas, CA 95035 Manteca, CA 95336 <br /> Phone(925) 458-9800 Phone (541) 745-2018 Phone (650)726-1819 Phone (408) 945-2800 Phone (2D9) 982.4298 <br /> Fax(925)458-9891 Fax(541)745-3826 ( ) { ) Fax(209) 9) 9820 9 <br /> Fax 650 726.9183 Fax 408 262-2871 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> .� GENERATOR •?id:: ' <br /> WASTE ACCEPTANCE Na. <br /> M ILING ADD ESS <br /> 20500 Stta1gft�� ire <br /> CITY, STATE, ZIP REQUIRED PERSONA!. PROTECTIVE EQUIPMENT <br /> PHONE ti =LOVES ❑ GOGGLES © RESPIRATOR IV <br /> HARD HAT <br /> CONTACT PERSON ❑TY•VEK CiSAFETY VEST <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE r <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Pad 261 or title 22 of the Catifomia 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 residueofa previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I codify and warrant that the waste has been treated in <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as drJfined by RECEIVING FACILITY <br /> 40 CFR Pad 261. �I <br /> WASTE: TYPE: <br /> ,.9_151'SPOSAL ❑SLUDGE _ <br /> ❑CONSTRUCTION <br /> Ll DEBRIS ❑WOOD <br /> C)OTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY <br /> 20509 Setah Hofty ire TRACY I <br /> TRANSPORTER . NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> r <br /> C E, <br /> -5241 . <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> --a,d _ ❑ LI <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> l <br /> © 0 CJ ❑ k <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 ❑ SOIL <br /> ❑ CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> ❑ WOOD <br /> � ❑ ASH <br /> ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3;00 P.M.THE DAY PRIOR TA EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT i <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DEUVERIESMUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. r <br /> Rev 11109 NS-024. GENERATOR.COPY <br /> MANIFEST# _ � I <br />