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1, <br /> Keller Canyon ❑ #Mountain ❑ Newby IS , d 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 /> rPFiBne(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 /> 1 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATORWASTE ACCEPTANCE NO. <br /> J.�rU �aA wry Crvvr.- /19as' r�To C ,eo /.,'T <br /> MAILINGADDRESS <br /> 37 fil ti 1 j' <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> } <br /> PHONE ❑GLOVES 0 GOGGLES l7 RESPIRATOR CdHARD HAT <br /> tl .SAr`e'Ty cz'OT`,S <br /> G' 7 ❑-TY-VEK L'i'OTHER „5447-aeZ7 <br /> CONTACT PERSON <br /> ff/✓ OH SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AG NT/TITL DATE <br /> GENERATORS CER((CATION:I hereby certify that the above named maternal is not a hazardous <br /> waste as defined by 40 CFP Part 261 or title 22 of the California code of regulations,has been property i <br /> described.classified antl packaged,and is in proper condition for transportation a'cording to applicable <br /> regulations;AND,if the waste In a traeMent residue of a prevlously resMctad haardous waste <br /> subject to the Land Disposal Restrictions,I cer ify and warrant that the 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 Pan 261. <br /> WASTE TYPE: <br /> O DISPOSAL 0 SLUDGE <br /> 0 CONSTRUCTION 0 WOOD <br /> 0 DEBRIS 0 OTHER <br /> dSPECIAL WASTE <br /> GENERATING FACILITY <br /> Qin 45- l��nuE <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS V� L n .� S — �U 1 Z 103 <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OFAUT ORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> * � L7 <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been r <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 /> 0 SOIL <br /> REMARKS '. <br /> 1 O CONSTRUCTION <br /> FACILITY TICKET NUMBER I <br /> DEBRIS <br /> 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT I DATE <br /> 1 10 WOOD <br /> ., \l <br /> \ I\_J I S� 0 ASH <br /> ,\ 0 SPECIAL OTHER <br /> zz <br /> SCHEDULING MUST BE MADE PRIORTO3:G0 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br />