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❑,Keller Canyon ❑ OpMountaln • ❑ Newby Island 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 /> w TOA re/ L?✓Tyr ?p5 urTo /l PSS? ,oGZ rsT <br /> MAILING ADDRESS _ <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> va�V& ❑GLOVES O GOGGLES ❑RESPIRATg� FXHARD HAT <br /> PHONE S'AGrry �GSwES <br /> ❑TY-VEK CC?THER � roeo <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED A NT/TIL DATE <br /> GENERATOR'S CER <br /> XFjCATION:I hereby Canty that the above named material is not a hazardous <br /> waste as defined by 4C'�FR Part 281 or title 22 of the California code of regulations,has been property <br /> described,classified and packaged,and is in proper condition for transportation a-cording to applicable - <br /> regulations;AND,R the waste Is a treatment residue of a Pravlously restricted hazardous waste <br /> subject to the land Disposal Restrictions,I oenify and warrant that me 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 281. <br /> WASTE TYPE: <br /> ❑DISPOSAL Q SLUDGE kew4le D 3:7vc" 44*,az-1 <br /> Q CONSTRUCTION Q WOOD <br /> 0 DEBRIS Q OTHER <br /> CKPECIAL WASTE <br /> GENERATING FACILITY <br /> SA/nE f}S /�.BcvE, <br /> TRANSPORTER. NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> )OJ'- <br /> ADDRESS <br /> CITY, STATS,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> S — U ❑ UF <br /> SIGNATURE OFAUTHORIZEDAGENT ORDRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ J <br /> CUBICYARDS <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 /> FACILITY TICKET NUMBERDEBRIS <br /> Q NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT i DATE <br /> o wood <br /> ❑ASH <br /> + • - ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 RKTHE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br />