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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island ❑ Forward <br /> Sanitary Lannlfill Sanitary Land,q, Sanitary Landfill Landfill <br /> 901 Batley Road 12310 San Mateo Ro,_j 1601 Dixon Landing <br /> Road 9999 S Austin Road <br /> Pittsburg, CA 94565 Halt Moon Bay,CA 9 o19 Milpitas,CA 95035Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(650)726-id19 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(925) 458-9891 Pax(6501726-9133 Fax(408) 262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATD WASTE ACCEPTANCE NO <br /> MAILING ADDRESS <br /> < <br /> CITY,STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> i C'� '+� �y r I T I� O GLOVES ❑GOGGLES O RESPIRATOR U HARD HAT <br /> PHONE r r r <br /> O TY VEK U OTHER <br /> CONTACT.PERSQN SPECIAL HANDLING PROCEDURES <br /> u <br /> SIGNATURE OF AUTHORIZED AGENT I TITLE DATE <br /> p a r•"- -1t trl� <br /> P�f t`'"L'?`t l!`l�' �. ,'-_•��`•-�i r t�,,•`J ;7<3l' �J'ii� t'£1 i` �r�Ct;,� i �Q r:z k i f_i <br /> GENERATORS CEFMFiCATION I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or htle 22 of the California code of regulations hes been property <br /> described dassified and packaged and is In proper condition for transportation a�cording to applicable <br /> regulations AND,Ii the wests Is a treatment reaidtie of a prevtousty restricted hazardous waste <br /> subject to the Lead Disposal Restrictions I oerUty and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFA Part 268 and is no longer a hazardous waste as defined by <br /> 4OCFRPart 26t '`:72" !`3 i 1,tF,i'c�° L 1 <br /> WASTE TYPE <br /> U DISPOSAL O SLUDGE <br /> 000NSTRUCTION OWOOD <br /> D DEBRIS Q OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Jim 7 <br /> ADDRESS t <br /> CITY,STATE, ZIP Y <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 5 3(", -i-_1 e , <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <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 /> ❑SOIL <br /> EMARKS U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> i � ( El WOOD <br /> ❑ASH <br /> ❑ SPECIAL OTHER <br /> REDUCING MUST BE MADE PRIORTO 3 00 P M.THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> O REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> rdnw,c_norm_nn_ e <br />