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s <br /> ❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island [j'�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)982-429E <br /> 10 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 /> MAILING AD ESS <br /> t 'If- <br /> CITY, <br /> I `CITY,STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE ❑GLOVES 0 GOGGLES I]RESPIRATOR O'HARD HAT <br /> �+ - J: >r '-�� i / `� 0TYVEK OOTHER <br /> CONTACT PERS N SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OFArWTHORIZED AGENT/TITLE DATE <br /> ? <br /> f t J j r � <br /> w:ERATO j FICATi0N I hereby cerUly that the above named material Is not a hazardous <br /> waste as 9 ned t>�40 CFR Rart 261 or tide 22 of the Caldomta code of regulasons has been properly <br /> dasorl6O4 ofassiod and packaged and Is Improper condition for transportation a-cording to eppllcabfe <br /> reguiatfpns AMRQ,If the well**Is a treatment residue of a txevlously restricted hazardous waste <br /> subfect to the kind Disposal f�estndtons I certrfy and warrant that the waste has been treated In RECEIVING FACILITY <br /> accordance with the requrremients of 40 CFR Part 266 and Is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 I I.I i a s'1 r 4 ... .1,.,�1 <br /> WASTE TYPE <br /> 0 DISPOSAL O SLUDGE at1 <br /> 000NSTRUCTION O WOOD <br /> 0 DEBRIS 0 OTHER <br /> 0 SPECIAL WASTE <br /> ZLNIRATING FACILITY <br /> I ' <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> d ' ► ' r_' . _ <br /> ADDRESS <br /> j>.0. 130X <br /> CITY,STATE,ZIP <br /> t <br /> PHONE END DUMP BOTTOM DUMP� TRANSFER <br /> SIGNATURE OF AUT#19RIZEQ A NT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> 1 <br /> CUBIC YARDS <br /> 1 hereby certify that the above named material has been <br /> accepted and to the beat of my knowledge the foregoing <br /> is true and accurate DISPOSAL METHOD {TO BE COMPLETED BY LANDFILL} <br /> DISPOSE OTHER <br /> MFIEMARKS ❑SOIL <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> C1 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT ?-s DATE <br /> 1 7 ! I 0 WOOD 1 <br /> j/ r <br /> o ASH <br /> 0 SPECIAL OTHER <br /> REDUCING MUST BE MADE PRIORTO 3.OQ P-M,TyE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> I <br /> IF REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> TRANSPORTER COPY aJAhnrcor- .^s.r. .-% J% — '-Ir <br />