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❑ !Caller Lanyon U Q�.Iountaln ❑ Newby Islam E]'Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 90.1 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> phone(9?5) 458-9800 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 /> GENERATOR �. <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> fiNE± <br /> U GLOVES O GOGGLES Q RESPIRATOR 0 HARD HAT <br /> PHO <br /> Q TY-VEK Q OTHER <br /> ICONTACT PERSO <br /> SPECIAL HANDLING PROCEDURES. <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CI=RTIFICAMON,.1 hereby certity:hal the above named material is not a hazardous <br /> wasle as defined by 40 CFR Pan 261 or title 22 of the California code of regulations,has been properly <br /> described,classified and packaged,and Is in proper condition for transpcdation a-cording to applicable <br /> regulations;AND,If the waste is■treatment residue of a pravlousty restricted hazardous waste <br /> subject to the Land Disposal Rastrlcilons,t certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 48 CFR Part 288 and is no longer a hazardous waste as defined by <br /> 40 CFR Pert 261. <br /> WASTE TYPE: <br /> U'b1SPOSAL 0 SLUDGE <br /> 0 CONSTRUCTION O WOOD <br /> U DEBRIS 0 OTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER _ NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDR'E S' <br /> CITY,STATE,ZIP <br /> PHONE r ' END DUMP BOTTOM DUMP TRANSFER <br /> ''"; ... :11 - �;r - ❑ ❑ <br /> SIGNATURE OF-AUTHORIZED AGENOR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <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 /> 0 <br /> REMARKS SOIL <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> Q WOOD <br /> Q ASH <br /> ' 0 SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIOR TO 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 /> MAMIFEST 0 s-n r•: <br /> GENERATOR COPY <br />