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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island 0 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 Mlipitas, CA 95035 Manteca,CA 95336 <br /> Phone (925)458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> 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 /> 0 � tit � ~jet <br /> MAILING ADDRESS <br /> V t r <br /> iiiiiiiiiiiiiiICI STAT7✓,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> J i'_T `t t t -I 1 O GLOVES O GOGGLES O RESPIRATOR A HARD HAT <br /> PHONE <br /> O TY-VEK O OTHER <br /> CONTACT PERSON , - SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> j,� (..aCitcl,c �.G1,rSx ,�,,• ��"rtf`� ,v�2Zr' <br /> (GENERATOR S CERTIFICATION i hereby codify 114t the above named material Is not a hazardous <br /> was as defined by 40 CFR Part 261 or title 22 of the California code of regulations has been properly <br /> described classified and packaged and is in proper condition for transportabon a cording to applicable <br /> regulations AND,If the waste Is s treatment residue of a previously restricted hazardous waste <br /> Subject to the Land Disposal Restrictions I certify and warrant that the waste has been ttaated In RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> O DISPOSAL O SLUDGE <br /> O CONSTRUCTION Q WOOD ksY«12 to rrt f CA :,5.f"ft' <br /> •DEBRIS U OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> TR SPQRTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRP.ESS <br /> F <br /> CITY,STATE,ZIP <br /> END•DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> �� f" .lj�# ❑ ID ❑ ❑ <br /> t rr <br /> 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 /> O SOIL <br /> EMARKS <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> � O WOOD <br /> , <br /> � Q ASH <br /> Z ^' r 'Q O SPECIAL OTHER <br /> ESCHIEDULING MUST BE 1W,ADE PRIORTO 3.00 P M THE DAY PRIOR TO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJEC <br /> O REFUSAL UPON ARRIVAL-ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> TRANSPORTER COPY MANIFEST# /9(3 n A P9/0 <br />