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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island ❑ 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)982-4298 <br /> Fax(925)458-9891 Fax(650) 726-9183 Fax(408)262-2871 Fax(209) 982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATO WASTE ACCEPTANCE N0. <br /> `T )1 �+ <br /> MAILING,� i,rRE57y <br /> CI STATE ZEP , REQUIRED PERSONAL. PROTECTIVE EQUIPMENT <br /> PHONEf r, � 0 GLOVES 0 GOGGLES 0 RESPIRATOR Cil HARD HAT <br /> ❑TY VEK a OTHER <br /> CONTACT PERSON ", L 5 - <br /> - - SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR S CERTIFICATION I hereby earthy,that ft above named material is not a hazardous <br /> waste es defined by 40 CFA Part 261 or title 22 of the Cahfom:e code of regulations has been property <br /> described classril and packaged and to in proper condition for transportation a,Cording to apph,cabie <br /> regulations ANA if the assts la a treatment residue of a previously restricted hazardous waste <br /> sub#W to the Land Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> 40 GFR Part 261 <br /> aocordanca with the requirements of 40 GFR Part 268 and is no longer a hazarduus waste as defined by <br /> ` <br /> *t ri„n A..4 _.1. <br /> WASTE TYPE <br /> 0 DISPOSAL 0 SLUDGE "°" '�" al-o <br /> ❑CONSTRUCTION 0 WOOD !I t! Lr e A <br /> 0 DEBRIS U OTHER <br /> CI SPECIAL WASTE <br /> GENERATING FACILITY <br /> T NS, EqiQTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS s <br /> F , <br /> CITY,STATE,ZIP <br /> PHrON}E a END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL bFF S FLAT-BED VAN DRUMS UMS <br /> J ' ❑ <br /> I <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 <br /> is true and accurate DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> EMARKS ❑ SOIL <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> SIGNATURE OFAUTHORI EDAGENT DATE ASBESTOS <br /> - 0 WOOD <br /> a ASH <br /> ] 5 <br /> U SPECIAL OTHER <br /> FaCHEDULING MUST SE MADE PRIORT0 3 00 P M.THE 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# 2 o !'y o <br />