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❑ Keller Canyon n ❑ Newby Island El Forward <br /> Sanitary Landfill Sanndt Andfill Sardtary Landfill Landfill <br /> 901 Bailey Road 12310 San Maao Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay,CA94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone (925) 458-9800 Phone(650)726-1819 none(408)945-2800 Phone(209)982 <br /> Fax (925)458-9891 Fax(650)726-9183 Fax(408) 262-2871 Fax(209)982-1 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR / WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS f f <br /> CITY,STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> it :r 7 1 I <br /> PHONE H �} t ❑GLOVES ❑GOGGLES ElRESPIRATOR E HARD HAT <br /> ' - J Ll TY-VEK Ll OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> r' <br /> .)n t 7 ac top 'j fl f S i`rF i1 c <br /> GENERATOR S CERTIFICATION I hereby cethat the above named matenal is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 2Z,ot the California code of regulations has been property <br /> described classified and packaged and is In proper condition for transportation a cording to applicable <br /> regulations AND,If the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the band Disposal Restrictions t certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> acoordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> 7"R770 it L --f-,t 1 <br /> WASTE TYPE <br /> y(.l tJ .� i ! .i l,x.. <br /> 0 DISPOSAL 0 SLUDGE <br /> 0 CONSTRUCTION 4 WOOD t 1 C U <br /> Ll DEBRIS Ct OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER1.111m Tharpe NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS 3A1_311 <br /> C ATEi-ZI:) <br /> PHIt—oNg _ END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OFAUTHORIZEDAGENTOR DRIVERDATE ROLL OFFS FLATBED VAN DRUMS <br /> r <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 /> REMARKS ❑SOIL <br /> 0 CONSTRUCTION <br /> FACILITY TIGKET NUMBER DEBRIS <br /> Q NON-FRIABLE: <br /> SIGNATURE OF AUTHORIZED AGENTDATE ASBESTOS <br /> O WOOD <br /> Lj �PSS <br /> t Q SPECIAL OTHER <br /> SCHEDUUNGrMUST BE MADE PRIORTO 3 00 P M THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br />