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t <br /> .e11er CanyonForward <br /> ElOx.Mountain El Newby Island <br /> r Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road <br /> 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> PittsbOrg, CA 94565 <br /> Phone(925 Half Moon Bay, CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> / 9 <br /> 458_ 800 Phone (650)726-1819 Phone (408)945-2800 Phone(209)982-4298 <br /> (/ Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209) 982-1009 <br /> ' NON-HAZARDOUS WASTE MANIFEST <br /> GENERATORWASTE ACCEPTANCE NO. <br /> 1'El j ev Y�(� lk sw c' n <br /> MAILING ADDRESS <br /> t=,4?-- T '�(.- --- 93 S .Z.0C) <br /> CITY, STATE,ZIP REQUIRED PERSONAL P TECTIVE EQUIPMENT <br /> , - <br /> - <br /> —h--; �- r '�'= D GLOVES D GOGGLES D RESPIRATOR 3p HARD HAT <br /> PHi N� <br /> (4,," ')8""8--_':a t= ❑TYVEK ❑OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> t;,""1 1rt: '7C1•• l;t? l T'S <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTEFICATION:I hereby certify that the above named material is not a hazardous <br /> waste as defined by 46 CFR Part 261 or title 22 of the California code of mgulations,has been properly <br /> described.classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> regulations;AND,If the waste is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Resl6clions.I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 26B and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: _ <br /> 'UDISPOSAL :1 SLUDGE `99, 4,US1r4Ln R <br /> CONSTRUCTION :1 WOOD ii?rzeca , CA 95113,3 <br /> •DEBRIS J OTHER <br /> D SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> t 'T'i:., ( T n <br /> ADDRESS <br /> CITY, STATE, ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER JDATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been r 1N <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 D SOIL <br /> ❑ CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHOR IZED'AGENT'/ :DATE <br /> f a WOOD <br /> ❑ASH <br /> � <br /> 0 0 SPECIAL OTHER <br /> tf r <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> MANIFEST#1508 4 <br /> Ge-WERA,TOF DOPY <br />