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LJ irmwoul LrQllyVll U VA IYIVUIILQ111 L__J 1YCWUy I*Ipllu 1 f"V1 wal <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfil <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S. Aja Road <br /> Pittsburg,CA 94565 Half Moon Bay, CA 94019 Milpitas,CA 95035 Manteca,,�S336 <br /> Phone (925)458-9800 Phone (650)726-1819 Phone (408)945-2800 Phone (2F91`482-4298 <br /> Fax(925)458-9891 Fax (650)726-9183 Fax(408) 262-2871 Fax(209)°2-1 009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE N0. <br /> MAILING ADDRESS <br /> 1713rja Mad 1-1,kw B144, 3JiJ:3 <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUkANT <br /> CA O GLOVES ❑GOGGLES ❑ RESPIRATOR C`k�D HAT <br /> PHONE <br /> a. `-•t °.'73F;'F;',g ❑TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> fel i+:;t.ta.�rtrxr gent gar <br /> ,J f i }iA:i'}ie�;at:ta:13<.,chic <br /> GENERATOR's CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properly <br /> described,classified and packaged,and is in proper condition for transportation a-cording to applicable.5 <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 inRECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> ; DISPOSAL ❑SLUDGE <br /> 0 CONSTRUCTION 0 WOPD <br /> 0 DEBRIS U OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> ;*. <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK'U11�1BER <br /> ADDRESS i ! !` �� <br /> CITY,STATE,ZIP <br /> PHONE END DUMP ` BOTTOM DUMP TSA(n"E�SFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> 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 LANC1`ILL) <br /> is true and accurate. <br /> DISPOSE CTHER <br /> O SOIL <br /> EMARKS — <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> 0 NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> U WOOD <br /> ❑ASH <br /> 0 SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P,M.THE DAY PRIORTO 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 /> GENERATI OR COPY MANIFEST# N; � i <br />