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LJ rener Vanyon LJ vX mouniain LJ Newby Islana i..jj rorwara <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 Sr 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 /> MAILING ADDRESS BB _ t <br /> 77 ,4:a 14t 4.3tr.F'et �.1�ia'. B.724:!'y <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE ❑GLOVES ❑GOGGLES O RESPIRATOR J HART? HAT <br /> ❑TY-VEK ❑OTHER <br /> CONTACT PERSON – <br /> s :� SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> r77mulorizeit p4vlfar <br /> f.'dl.T4Ak` <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 <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 /> &DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION r ❑WOOD _ <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE — <br /> GENERATING FACILITY -- <br /> 1 FE�Y�7l7:1.i➢Y2.d_.+g:.�.l�s3:fek8.&.'s ;_ter➢i,.t�.i,*T� <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER-F TRUCK NUMBER <br /> c• L � � t >;I� _ r <br /> ADDRESS _ <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 /> V V <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 /> EMARKS SOIL <br /> ❑CONSTRUCTION I <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑WOOD <br /> ❑ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE A-jORTO 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 /> GENERATOR COPYMANIFEST# 3 13 <br />