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❑ Keller Canyon ❑ PMountain ❑ Ne"y 11snd. ;. KForward <br /> Sanitary Landfill = -Sanitary Landfill' , - Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road1601 Dixon Landing Road 99993.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(4,08)262.2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> APNIZ /Yl cu C <br /> MAILING'ADDRESS <br /> ,200 m <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> lI OD! C g O GLOVES O GOGGLES ❑ RESPIRATORARD HAT <br /> [, PHONE _ ❑TY-VEK Gl(OTHER ,S.9ic�7y �� <br /> [[[[ 57z�FG 7a5,49CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGE T/TITLE JDATE <br /> GENERATOR'S CER13ACATION:I hereby ceft'dy that the above named material is not a hazardous <br /> waste as defined by 40 CFR Pan 261 or title 22 o1 Ne Caltfomia code of regulations,has been propery <br /> described,classified and packaged,and is in proper condition for transportation a^ rding to applicable <br /> regulalions;ANO,If fine waste Is a bsebnont m1due of s prevlouoly restricted.hasardoue west- <br /> ''jj subiecl to the land Disposal Restrictions,I cadify and warrant that the waste has been treated in -RECEIVING FACILITY <br /> { accordance with the requirements of 40 CFR Pan 268 and is no longer a hazardous waste as defined by <br /> 4 40 CFR Pad 261. <br /> WASTE TYPE: p�aW�}/1� NC: 721st FidC - <br /> ❑DISPOSAL. � ❑SLUDGE n <br /> C1 CONSTRUCTION ❑WOOD I�IAiU'7"C—C��It t� <br /> ❑DEBRIS ❑OTHER <br /> ,P:SPECIAL WASTE ' <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCKNUMBER <br /> OC(� �Q <br /> ADDRESS' X36 <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AG NT OR DRIVER JDATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> r � <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 /> REMARKS <br /> ❑CONSTRUCTION <br /> I <br /> FACILITY TICKET NUMBER " -'---� NON- S ONON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OFAUTHORIZEDAGENT, DATE <br /> 0W000 <br /> l� <br /> ❑ASH <br /> ' , I ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIQRTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br />