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L-i Kener canyon ❑ Ox Mountain ❑ Newby Island ( %Forward <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 /> GENERATOR WASTE ACCEPTANCE NO. <br /> 3 aS.be t4_l�.> >J<33 fl.W.. i':t<:4..13 i.L• <br /> MAILING ADDRESS <br /> '7i' Be-ale �St�c-A Flail(.'.,ode B:,4%�� '��V.7 — <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE Q GLOVES Q GOGGLES Q RESPIRATOR Q HARD HAT <br /> E_ .3"11 Q TY-VEK Q OTHER <br /> CONTACT PERSON <br /> s,> �, SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> Ateborizeni <br /> N UAW <br /> I <br /> NERATOR'S CERTIFICATION:I hereby certity that the above named material is not a hazardous <br /> ste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properly <br /> scribed,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> ulations;AND,If the waste is a treatment residue of a previously restricted hazardous waste <br /> bject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated inRECJzIVING FACILITY <br /> cordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined byCFR Part 261. <br /> STE TYPE: <br /> '-DISPOSAL O SLUDGE <br /> ❑CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER i <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> 8....rSt {� <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER I TRUCK NUMBER <br /> ADDRESS f _ 1 <br /> CITY, STATE,ZIP <br /> Cts _54'+2 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE QF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> r� Ps. i ❑ ❑ ❑ZJ <br /> ❑ <br /> 7 <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: <br /> is true and accurate.is BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> REMARKS U SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> U WOOD <br /> U ASH <br /> U 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 /> GENERAJ OR COPY MANIFEST# '1 A 1 P v? 'E <br />