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❑ Keller Canyon , ❑ Ox Mountain ❑ Newby Island [�4-Fal`ward <br /> Sanitary Landfill S&tary Landfill Sanitary Sdfill Landfill <br /> 901 Bailey Road 12 San Mateo Road 1601 Dixon La ding 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 /> Fa::(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209) 982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> gGENERATORiTicehire-G WASTE ACCEPTANCE NO. <br /> DRESS <br /> cri ST d4P <br /> ,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> v J � �' ( 2-O ❑GLOVES OGOGGLES ❑RESPIRATOR U HARD HAT <br /> 73 7-7 11 ❑TY-VEK ❑OTHER <br /> ERSON <br /> n— „_� SPECIAL HANDLING PROCEDURES: <br /> „. SIGNATUREOFAUTHORIZEDAGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION.I hereby cedity that the some named material is not a hazardous <br /> waste as defined by 4D CFR Pad 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 azcording to applicable <br /> regulations;AND,If the waste Is a treatment residue of a preelously restricted hanrdous waste <br /> subject to the Land Disposal Restrictions,I badly,and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements 0140 CFR Pad 266 and is no longer a hazardous waste as defined by <br /> 40 CFR Pa 261. <br /> WAST PE: <br /> DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> O DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> HoAs c P" <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS f oo.�Z <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> D 3R 110-1 ❑ ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> D ❑ ❑ g ❑ <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 /> REMARKS ❑ SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE �\ <br /> S� <br /> SIGNATURE.OFQUTHORIZEDAGENT DATE ASBESTOS <br /> WOOD <br /> GASH <br /> 0 SPECIAL OTHER <br /> l <br /> r <br /> SCHEDULING MUST BE MADE PRIORTO3:00 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 /> MANIFEST# 10 10 0 03 <br /> TR4NF?DRTER COPY <br />