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r- - <br /> 11 ' ❑ Keller Canyon El-ox Mountain CI Newby Island ❑ Forward <br /> S,anit- y,Landfill Sanitary L'andflfl Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> '16 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) 982-429E <br /> Fax(925)458-9891 Fax(650)726-9183 Fax (408)262-2871 Fax(209)982-1009 <br /> NON-HAZADOUSIVASTE MANIFEST <br /> GENERATOR•"% , ,� , <br /> I WASTE ACCEPTANCE NO. r <br /> ' MAILING ADDRESS ' <br /> CITY,STATE,_ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE O GLOVES O GOGGLES ❑RESPIRATOR 0 HARD HAT! , <br /> O TY VEK U OTHER <br /> CONTACT PERSON , 4 <br /> ' 1 ,-./ , A- SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> 01/GENERATOR S 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 been properly <br /> described classified and packaged and is in proper oond,tion for transportation a-cording to applicableregulations AND If the waste Is s treatment residua of a previously restricted hazardous waste <br /> subject to the Land Disposaf Restrictions I certify and warrant that the waste has been treated m RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> O DISPOSAL 4 SLUDGE <br /> O CONSTRUCTION O WOOD <br /> O DEBRIS HER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER /j' ,r '' -T-, NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY,STATE,ZIP <br /> ' PHONE ' - r r ( 14END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> ' SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROL FF(S) FLAT-BED VAN DRUMS <br /> l ❑ ❑ ❑ ❑ <br /> 1 � /II <br /> 4 <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 /> d DISPOSE OTHER <br /> O SOIL <br /> REMARKS O CONSTRUCTION <br /> FACILITY TICKET NUMBER I DEBRIS <br /> 1O NON FRIABLE <br /> ASBESTOS <br /> SIGNATURE AUT ORIZE AGENT DATE <br /> �i ❑WOOD <br /> ❑ASH <br /> 1 1' O SPECIAL OTHER <br /> ' SCHEDULING MUST BE MADE PRIORT0 3 OO P M THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJE( <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFOR <br />