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❑ Keller Canyon [) Ox Mountain ❑ Newby Island [3 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)982-429 <br /> Fax(925)458-9891 Fak(650)726-9183 Fax(408) 262-2871 Fax(209)982-11@ <br /> I <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR t %7' WASTE ACCEPTANCE NO <br /> Pr a <br /> MAILING ADDRESS <br /> CITY,STATE,Zip REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> i :r PHONE <br /> O GLOVES O GOGGLES O RESPIRATOR allARD HAT <br /> r ✓ O TY VEK O OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF UTHOR�IZED AGENT/TITLE DATE <br /> P ;-`oil: r1,�t.e�2 ;� r, � .e� Hol. <br /> r r /�4+ / ~ <br /> GE!jt?FU}TOp 5 C FlTIFIC iorl I hereb{certify ttryt the above named material is not hazarddus <br /> s W IS as defined by 40 GFR Pan 261 or tine 22 of tbb California code of regulations has been property <br /> ?= described ciasssJJtied and packaged land is in prop9/condition for transportation a carding to applicable <br /> "(dations AN if the waste la a treatment residua of a previously restricted hazardous waste <br /> wtiject to the Land Disposaf Restnc ons i usnrV and warrant mai the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of40 CFR P,an 268 and is no longer a hazardous waste as defined by <br /> r `y 40 CFR Pan 281 «� ��tt r<Ll"rC'L�.L <br /> WASTE TYPE <br /> 0 DISPOSAL ❑SLUDGE -,,9913 1x12({ <br /> 13 CONSTRUCTION O WOOD t,��� �/;t , 1 <br /> O DEBRIS O OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICE77F <br /> TRUCK NUMBER <br /> �t L';1 r'cc3Z't3E: 1.L ,�"t3 <br /> ADDRESS -�" <br /> CITY,STATE,ZIP <br /> PHONE ENQDUMP BOTTOM DUMP TRANSFER <br /> r <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT BED VAN DRUMS <br /> k ❑ a d d <br /> j CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing <br /> Is true and accurate DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> EMARKS Q SOIL <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> SIGNATURE OFAUTHORIZED GENT �w DATE ASBESTOS <br /> O WOOD 3+ `. <br /> ` ' , } ' I►]ASH <br /> O SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIbRTO 3.00 P.M THE 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 />