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u ncnCr .,dilyull u ux mountain U Newby Island a 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 /> MAILING ADDRESS <br /> yy y - <br /> ,;bi'ea'Cf _�"3:i�-0-Cod(,, .�,l.t-0lA' — <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> a3t <1yc_et <br /> PHONE ❑GLOVES ❑GOGGLES ❑ RESPIRATOR ❑HARD HAT <br /> "` i 5) 3' $!! ' ❑TY-VEK ❑OTHER <br /> CONTACT PERSON _ <br /> i ;JSPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> s W..r q% it <br /> �_ '�``� 1'3cifsc Cnc;he flectr•.r. ap' <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 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 by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> ❑DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> kENERATING FACILITY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER € <br /> £a `- <br /> ADDR <br /> CITY, STATE, ZIP <br /> PHONE I <br /> ENDDUMP BOTTOM DUMP TRANSFER I <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL OFFS) FLAT-BED VAN DRUMS <br /> * fi ❑ U <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been I <br /> accepted and to the best of my knowledge the foregoing <br /> IS true and accurate. DISPOSP,L METHOD: (TO BE COMPLETED BY LANDFILL) I <br /> DISPOSE OTHER <br /> EMARKS _ ❑ SOIL <br /> ❑ CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> SIGNATURE OF WOOD <br /> AUTHORIZED AGENT DATE ASBESTOS <br /> ooD <br /> ❑ASH <br /> ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 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 /> GEANER OR COPY MANIFEST# ,� <br />