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u rmler canyon u ux mountain u IVeWDy Islana .n 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 /> 77 eu <br /> 'CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE O GLOVES U GOGGLES LlRESPIRATOR O HARD HAT <br /> (415)!473-3773 O TY-VEK C)OTHER <br /> CONTACT PERSON <br /> Robes Gray SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT!TITLE DATE <br /> '-�G-G•'..c,.= :7-- f <br /> kvo <br /> GENERATOR'S CERTIFICATION:-.I hereify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or big of the California code of regulations,has been property <br /> a 4 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 prevlousty restricted hazardous waste <br /> Subject to the Land Disposal.Restrictions,Icerfify 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 Pail 261. <br /> WASTE TYPE: <br /> ' DISPOSAL 0 SLUDGE <br /> # O CONSTRUCTION O WOOD <br /> D DEBRIS O OTHER <br /> D.SPECIAL WASTE <br /> GENERATING FACILITY <br /> Li r O b LATMOP <br /> ..SrT�y.� " NOTES: VEHICLE LICENSE.-UMBER TA00R,NUMBER <br /> � k;.,. <br /> e*'Transportafift , <br /> DDRESS . <br /> 01DenBeste Cotut <br /> STATE,ZIP ( ` <br /> OrICA 95492 <br /> ;PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 7tJ 838-1407 L) 0 <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> 44,1y <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 /> ❑SOIL <br /> EMARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> O ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST# ;)n q l;q q <br />