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Newby Island <br /> J�owaid <br />' Sanitary Landfill Sanitary Landfill Sanitary Landfill Lan ill <br /> `DOT Bailey Road - 12310 San Mateo Road 1801 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay, CA 94019 Milpitas, CA 95035 Manteca,CA 95336 <br /> Ph6M (925) 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-HAZAR©QS WASTE MANIFEST <br /> GENERATOR r � <br /> r WASTE ACCEPTANCE NO. <br /> �1 <br /> MAILING ADDRESS,'., <br /> L1 i <br /> CITY, STATE, Zip., "' ^-• .-REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE rA1 f �� �° 0 GLOVES Q GOGGLES Q RESPIRATOR Q HARD HAT <br /> -.,,. -0TY-VEK O OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br />' SIGNATURE OF AUTHORIZED AGENT/TITLE DATE VO - <br /> GENERATOR S CERTIFICATION I hereby certify that the above named matenal is not a hazardous j <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations has been prop�� <br /> described,classified and packaged and u in proper condition for transportation a-cording to ap rMIS1 <br /> regulations AND,tf this waste Is a treatment maldae of a previously restricted hazardous waste <br /> WNW to the Land Disposal Restrictions I certify and warrant that the waste has been treated in - RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as-pefined by <br /> 40 CFO Part 261 <br /> WASTE TYPE 4 <br /> 0 DISPOSAL Q SLUDGE <br /> O CONSTRUCTION Q W OD <br />' U DEBRIS <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER A r ,r) ' _ NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br />' ADDRESS r 4 S <br /> CITY, STATE, ZIP <br /> PHONE <br /> - END DUMP BOTTOM DUMP TRANSFER--' <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> Ll Lk U <br /> sic - r} <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 DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate <br /> DISPOSE OTHER <br /> EMARKS O SOIL <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> 0 NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGE ASBESTOS <br /> 0 WOOD <br /> 0 ASH <br /> 0 SPECIAL OTHER <br /> Y <br /> ISCHEDULING MUST BE MADE PRIORf0 3.04 RM.THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REIFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> . .. A+t,A�'f'? <br />