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L_r •-V..V• VM..'v.• LJ vw •-.V V..aY..• LJ --y •V.M-.— r!`.,y ■ 1.01 Vtg8V <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 /> „ ## <br /> ,M.s�.vLA��: 1149 13i,, l...L6r(:M".YiE., <br /> MAILING ADDRESS Ai <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Izt <br /> PHONE <br /> -W- � I O GLOVES U GOGGLES 0 RESPIRATOR O HARD HAT <br /> 04 S 5) "..f`3 37`3 U TY VEK U OTHER <br /> CONTACT PERSON <br /> Robort G av SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> ' A.lSi Ui'1Ld'd Age(d Wr <br /> i!5 ` / r+ssiYir,fiias f. loatsis , <br /> GENERATOR'S CERTIVICATION: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 property :> <br /> described,classified and packaged,and is in proper condition for transportation a'cording to applicable <br /> regulations;AND,If the waste Is s 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 by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> ISPOSAL U SLUDGE <br /> U CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> •SPECIAL WASTE <br /> GENERATING FACILITY <br /> i .ca�.de�tairN ><��Iraias� 'f'4.tcsr�t4€z€s <br /> TRANSPORTER _ NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESSIlk <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 /> ( 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 /> ❑ <br /> REMARKS SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 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 /> GENET i OR COPY MANIFEST# 1 7 <br />