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Li mener canyon ❑ (%.,M®untain ❑ Newby Islam <br /> Sanitary Landfill Sanitar Landfill Forward <br /> 901 Bailey Road 12310 San Mafeo Road Sanitary Landfill Landfill <br /> Pittsburg,CA 94565 94019 1601 Dixon Landing Road <br /> Half Moon Bay, 9999 S.Austin Road <br /> Phone(925)458-9804 Phone(650)726-1-1 Milpitas, CA 95035819 Phone(408) 945-2800 Manteca,CA 9336 <br /> Fax(925)458-9891 Fax(650} 726 9383 Phone(209)982-4298 <br /> Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> Al WASTE ACCEPTANCE N0, <br /> MLING"ADDRESS <br /> CITY,STATE, ZIP <br /> REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE - U GLOVES G GOGGLES U RESPIRATOR U HARD HAT <br /> ' <br /> C'•NTACT PERS-ON ❑TY-VEK U OTHER <br /> µ <br /> H <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE ANDLING PROCEDURES: <br /> DATE SPECIAL <br /> �GEtJERATOR'S CERTIFICATION:i hereby certify that the above named material is not a hazardaus <br /> waste as ealinad by 40 CFR Part 261 Of lilla 22 of the California code of ragufations,has been properly <br /> described,classilied and packaged,and is in proper condition far transportation a'cording to applicable <br /> regulalions;AND,If the waste Is a treatment residue of a Previously restricted hazardous waste <br /> Subacccordance wiihe th he requirementsrictions,1 of 0 CFR Part 268 and and sot that the waste no longer a hazards been ous wasreated in <br /> le as defined by <br /> 40 CFR Part 261, RECEIVING FACILITY <br /> WASTE TYPE: <br /> 000 POSAL U SLUDGE <br /> U CONSTRUCTION O WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> ;rfy <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ef <br /> ADDRESS .1 r <br /> ! <br /> i._ <br /> CITY, TATE,ZIP <br /> -�1.:�'i i!• ,Vie. 7 .1 �_�..:: ' ._. <br /> PH NF I ' <br /> END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVERpgTE ROLL-OFF(S) ❑ <br /> FLAT-BED VAN DRUMS <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 O SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> 0 NON-FRIABLE <br /> SIGNATURE OF.AUTHORIZED AGENTDATE ASBESTOS <br /> Q WOOD <br /> U ASH <br /> 4 SPECIAL OTHER <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 R <br /> [3�,lF�4��701-[CUf'r <br />