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❑ Keller Canyon ❑ Oz Mountain ❑ Newby Isld ❑ 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 /> " 5,01V Jogoo 1Y Cao ul fo C &! As <br /> MAILING ADDRESS L <br /> p� GK 1 � — <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> c. Q GLOVES Q GOGGLES Q RESPIRATOR I.7Y,HARD HAT <br /> PHONE QTY-VEK OTHER `S L/i�v&4kj,<A5 <br /> CONTACT PERSON <br /> i oe 1 SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> u l-IORfZF /15�-_y�--nrC�u�N2�' <br /> I GENERATOR'S CERTFICATION:I hereby certify Nat the above named material is not a hazardous - <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property - <br /> described,classified and packaged,and is in proper conQtlion for transportation a-mmingto applicable <br /> regulatfons;AND,If the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the Lard DisposalAesthctiorw,l certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> eccartlarce with thetI,- I enta di 40 CFR Part 26B and is no longer a hazardous waste as defined by N <br /> E —AO CFRPad261. <br /> WASTE TYPE: <br /> '❑DISPOSAL - Q SLUDGE / <br /> U CONSTRUCTION ❑WOOD <br /> -O DEBRIS - ❑OTHERi <iAll <br /> q(SPECIAL WASTE. - - <br /> GENERATING FACILITY <br /> )VS 1-24 6 tv e-- <br /> TRANSPORTER - AflH - J�IY'J!;/YYl(/ NOTES: VEHICLEUCC'ENSENUMBER TRUCK UMBER <br /> ADD � ORESS 2 J S✓ � 7©I 1 &I-a <br /> j CITY,.STATE,ZIP C)Q M I C, Q <br /> II PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OFAUT`HORIZED AGENT OR DRIVER DATE ROLLOFF(S) FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been �O <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 /> Q SOIL <br /> REMARKS <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBS- DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑WOOD <br /> <!(�,j� t� `.'�• ,:.1-l"� %��j` ❑ASH <br /> % O SPECIAL OTHER- <br /> SCHEDULING\RUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br />