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[] Keller Canyon ❑ Ox Mountain ❑ Newby Island [} 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)982-425 <br /> Fax(925)458-9891 Fax(650) 726-9183 Fax(408) 262-2871 Fax (209) 982-1 T <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR r— <br /> }, r WASTE ACCEPTANCE NO. <br /> I <br /> AILING ADPRES, <br /> ITY, ATE, ZIPREQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> f ' O GLOVES ❑GOGGLES 0 RESPIRATORHARD HAT <br /> HONE r ❑TY-VEK D OTHER <br /> ONTACT PERSONSPECIAL HANDLING PROCEDURES <br /> IGNATURE OF AUTHORIZED AGENT/TITLE DAT <br /> .Fid h w <br /> _197 <br /> ' GENERATOR S CERTIFICATION I hereby certi4that the above named material is not a hazardous <br /> waste as defined by 40 CFA Part 261 or title 22 of the Cahfornta code of regulations has been property <br /> described classified and packaged and is in proper condition for transportation a-cording to awicabie <br /> regulations AND,If the waste to a trestri rit residue of a previously restricted hazardous waste <br /> subject to the land Disposal Restnctrons I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> °a. accordance with the requirements of 40 CFR Pan 266 and is no longer a Hazardous waste as defined by <br /> i 40 CFR Part 261 <br /> WASTE TYPE I'�O:"�v i 1• Lt�txci i Z <br /> n 3ti <br /> O DISPOSAL Q SLUDGE 1 J. " <br /> OCONSTRUCTION OWOOb .iia <br /> O DEBRIS ❑OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLTE LICEtNSE NUMBER < TRUCK NUMBER <br /> Jim Phorpe U11 , j z—ic» <br /> AD RES5 <br /> t ".� <br /> CI , ST TE, IP _ <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> !1 ❑ ❑ ❑ ❑ <br /> /r �� E t <br /> 1 <br /> CUBIC YARDS <br /> 1 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 ❑ SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑WOOD <br /> O ASH <br /> t , O SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIQRTO 3.00 P M.THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON AilIRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br />