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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island _[Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> W1 432iili;y 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 /> r � NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS V j <br /> I {) o to i jyl, , _ w Z <br /> CITY,STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE y E5 D GOGGLES D RESPIRATOR -t:7�ARD HAT <br /> Q TY-VEK U OTHER <br /> CONTACT PERSON <br /> �� S `� ! SPECIAL HANDLING PROCEDURES: <br /> PA <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> i f �(j� {J{ R� <br /> ',t �L..i�v-1 P'.1-3 ns"� Mq.)?yam ASL tAo <br /> GENERATOR'S CERTIFICATION:I hereby candy that tfre 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,class and and packaged,and is in proper condition for transportation ancording to applicable <br /> regulations;ANA If the waste is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions.I candy and warrant that waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no r a hazardous waste as defined by <br /> 40 CFR Pan 261. <br /> WASTE TYPE: <br /> Ci DISPOSAL Q SLUDGE <br /> Q CONSTRUCTION Q WOOD <br /> ❑DEBRIS Q OTHER <br /> •SPECIAL WASTE <br /> GENERATING FACILITY <br /> S• c +L�—•, cA ' ' <br /> I RANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS- , <br /> CITY,STATE,ZIP i <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS / <br /> ❑ ❑ ❑ ' <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 /> REMARKSD SOIL .. <br /> Q CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER Q NON-FRIABLE 1 <br /> ASBESTOS <br /> SIGNATURE OF-AUTHORIZED AGENT DATE <br /> Q WOOD <br /> O ASH <br /> { <br /> ` •-•O SPECIAL OTHER ' <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 RM'.THE DAY PRIORTO EXPECTED ARRIVAL 4,ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL,THE DAY BEFORE. <br /> GENERATOR COPY 27320m, <br /> MANIFEST N <br />