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LI Keuer t,;anyon Ll ux mountain L Newoy isiana U .1-Orwara <br /> Sanitary Landfill -Sanitary Landfill Sanitary Landfill Landfill <br /> 901 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 (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-HAZARDOUS WASTE MANIFEST <br /> GENE ATpR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY, STATE,ZIP . REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> GLOVES J GOGGLES ❑ RESPIRATOR J HARD HAT <br /> PHONE <br /> ;a i 5,1 973"b–A r '<. J TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF//AUTHORIZED AGENT/TITLE DATE <br /> fJ.. .. t -t t 1.i <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CSR Part 261 or title 22 of the California code of regulations,has been properly l <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 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 defined b� <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> _-DISPOSAL ❑SLUDGE <br /> •CONSTRUCTION C]WOOD I <br /> ❑DEBRIS Q OTHER i <br /> •SPECIAL WASTE <br /> GENERATING FACILITY -- <br /> i <br /> J TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> : _ f� -.. „moi . 'j, +,.... :. • — _ .. ._� <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> �, � ,� ��' y�"t '�`w.,rw.�-�. _Maw ❑ ❑ ❑ ❑ <br /> w <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 /> Q SOIL <br /> EMARKS <br /> I,CONSTRUCTION ^— <br /> FACILITY TICKET NUMBER DEBRIS <br /> NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> O ASH <br /> O SPECIAL OTHER <br /> 9 L* <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> MANIFEST# ; <br /> Gc� c�P.A',OP.GAY <br />