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Q Keller Canyon ❑ Ox Mountain r (] Newby Island P-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 <br /> Fax <br /> hone(209)982Fax(925) 458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR I'� ,__� �� /�, - f:� ` <br /> f =� WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS,,/ A,, <br /> CITY,STATE, ZIP 'r ter,; ,��' �;,' r'Z� REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE <br /> U GLOVES U GOGGLES O RESPIRATOR U HARD HAT <br /> _ U TY-VEK U OTHER <br /> CONTACT PERSONSPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT I TITLE DATE _ f <br /> GENERATORS CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations has boon properly <br /> described classified and packaged and Is in proper condition for transportation a-cording to appi"bie <br /> regulations AND,If the waste Is a treatment residua of a previousty restricted hazardous waste <br /> subject to the Land Disposal Restrictions I corbfy and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Pan 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> O DISPOSAL U SLUDGE <br /> I CONSTRUCTION ID WOOD <br /> ❑DEBRIS Z.QTHER <br /> •SPECIAL WASTE f <br /> GENERATING FACILITY r <br /> TRANSPORTER 1 . ,�-�- NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS ? -1� ., N, / !•t ��% 6 `� /� <br /> CITY,STATE,ZIP 1 ,• { f ��F� ��i���'� ;� <br /> PHONE END DUMP` BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S FLAT-BED VAN DRUMS <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 /> EMARKS U SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> SIGNATUFE OF AUTHORIZED GENT ASBESTOS <br /> DATE <br /> O WOOD <br /> 0 ASIS <br /> O SP AL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3 00 P M THE DAY PRIOR TO EXPECTE6 ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJEC <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MIDST BF SCHFDin Fn WITH Tum I AunCll I Tutt: r,AV eeenRl <br />