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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island [!Forward <br /> Sanitary,Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 Sart 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)982-4298 <br /> Fax(925)458-9891 Fax (650) 726-9183 Fax(408)262-2871 Fax(209) 982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR NN' WASTE ACCEPTANCE NO. <br /> MAILING AD ESS <br /> CITY, STATE, ZIP <br /> wrw' _ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> � ✓ �.° °1' ,.-rf 3 "� I i r "�+1 Drs <br /> PHONE ❑GLOVES a GOGGLES ❑RESPIRATOR U"HARD HAT <br /> ' g2 !z T / ` Q TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> t s x <br /> ,✓ I d <br /> GENERATG FICAT(ON I hereby certify that the above reamed material is not a hazardous <br /> wash asp nad t640 CPR Hart 261 or title 22 of the Caldomia code of regulatwns has been proper) <br /> desc+H;q classified and packaged and is improper condition for transportation a-cording to applicable <br /> re¢uiatWAs AN it the west*Is a tmatmartt moldue of a previously restricted hazardous'ins <br /> aste <br /> aubfect to the Disposal estricb,ons I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance w the raqueent`ents of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR part 261 t 1 in 1'u ra 31 x a 1 <br /> WASTE TYPE <br /> Q DISPOSAL O SLUDGE Q zy a Ch R" '+ ii { <br /> ❑CONSTRUCTION Q WOOD <br /> 0 DEBRIS CI OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> I \' <br /> TDD <br /> PORTER NOTES VEHICLE LICENSE NUMBQi TRUCK NUMBER <br /> p EEC . <br /> SS pyy ��`J30 3,)ATE,ZIP + <br /> ENtPHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED A NT OR DRIVER DATE ROLL-OFFS 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 Q SOIL <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> SIGNATURE OFAUTHORIZED AGE DATE ASBESTOS <br /> - ❑WOOD i <br /> r-• ' r <br /> ! ❑ASH <br /> a SPECIAL OTHER <br /> I fgHEDULING MUST BE MADE PRIORTO 3.00 P"M,TyE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> TRANSPORTER COPY MANIFEST# X33 g� 8Q <br /> 97 <br /> r <br />