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N [] Newby Island [] Forward <br /> El Keller Canyon ❑ ox Mountain ❑ <br /> San" Landfill A- Landfill <br /> Sanitary Landfill Sanitary Landfill 1601 Dixon Landing Road W99 S.Austin Road <br /> goi Bailey Road 12310 San Mateo Road <br /> Pittsburg,CA 94665 Haff Moon Bay:CA 94019 Mil pbs,CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(650)726-1819 Phone(408)945-2600- Phone(209)982,4298 <br /> Fax(925)458-9891 Fax(650)725-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> TATE,ZIP REQUIREDPROTECTIVER <br /> CITY,S <br /> Q GLOVES 0 GOGGLES CI RESPIRATOR WhCARD HAT <br /> PH M. <br /> Q TY-VEK 0 OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> -OFAuTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I jonby emuty"t the awwo named miss is MX a haMd= <br /> waste as doMW by 40 CFR Fatt 261 or Uft 22 at die cavQ&cc&at regulations,has bean Inwriy <br /> des bed c1sa lftc!and pa**WL and is in proper carAllon for vansimtow amo dna b applicabis; <br /> MgLAmftu;AND.11 the WOM in is Vembiwa md"of a pmyjc%gpiii�ms&hftd haveftus vmM <br /> inns,I cog*and wanwit u*ow waste ha bmn fta%d in RECEIVING FACILITY <br /> :h0=1har=4 =1 40 CFR PM 20 and is no ingw a imsifto wasm as desied by <br /> 40 CFR Pad 261. <br /> WASTE TYPE: <br /> •DISPOSAL USLUDGE <br /> •CONSTRUCTION QWOOD <br /> 0 DEBRIS U-43HER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> PHONE " END DUMP BOTTOM Dump TRANSFER <br /> Sl NAT1lR OF A-UTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I hereby certify that thea named material has been <br /> accepted and to the best of my knowledge the foregolnM 1Dkq'0ShIfMETHOD.- (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> 0 SOIL_ <br /> REMARKS CONSTRUCTION <br /> DEBRIS <br /> FACE.IIYTICKETNUMBER 0 NON-FRIABLE <br /> ASSESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ®WOOD <br /> 0 ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BEM PRIORTO 3:00 PJA.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL-ONGOINr. oAlty nreuntpRipa miurr imp _mnworull wn warms'1"0 1^Nr%=1q I 'rUC nAV MCM^00 <br /> S -d BO*18_698 Ohl IWOlUd M313d e6e :LD 9D 22 2nd <br />