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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island Q 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)982-4291 <br /> Fax(925)458-9891 Fax(650) 726-9183 Fax(408)262-2871 Fax(209) 982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATO ,_ <br /> ­ IIt , WASTE ACCEPTANCE NO. <br /> MAILING¢ LDRES, <br /> CI STATE ZIP , REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> t; <br /> PHONEr ,f- ❑GLOVES O GOGGLES U RESPIRATOR Gi HARD HAT <br /> 1 + Q TY VEK U OTHER <br /> CONTACT PERSON "'`, �- r` >F-- r <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> N. t` <br /> N. '))ti <br /> GENERATORS CERTIFICATION I hereby certity that the above named material is not a laizardous <br /> waste es daUnetl ay 40 CFR Part 261 or Me 22 of the California code of regulations has been properly <br /> detc�lbed ctassihed and packaged and is in proper cor,dNwn for transportation a^cording to applocabfe <br /> regulations AND,if the waste In a treatment residue of a previously restricted hazard os waste <br /> subject to the Land Disposal Restrictions I certify and warrant that the waste has been treatued in RECEIVING FACILITY <br /> accordance with the requiremonts of 40 GFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Pan 261 .1- <br /> WASTE TYPE <br /> Q DISPOSAL U SLUDGE <br /> UCONSTRUCTION O WOOD Pi tt)V 'f.a y A. <br /> U DEBRIS U OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSP TER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> . } xx <br /> ADDRESS `a ? A 9 3('i r y_ <br /> CITY,STATE,ZIP <br /> Jet 11'e L , 1✓ :F <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> I ( %I)'t i L) <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> - f r a a a o <br /> I <br /> I CUBIC YARDS <br /> 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 /> EMARKS o SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHOR! ED AGENT DATE <br /> - O WOOD <br /> C3 ASH <br /> O SPECIAL OTHER <br /> IIEDULING MUST 8E MADE PR(ORTO 3 00 P M.THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> REFUSAL UPON ARRIVAL OT+IGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> TRANSPORTER COPY .... r .. .1 — — <br />