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❑ Keller Canyon ❑ OX Mountain ❑ Newby Island [l Forward <br /> Sanitary LanWflll Sanitary Land>all Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Ror.� 1601 Dixon Landing <br /> Road 9999 S Austin Road <br /> Pittsburg, CA 94565 Half Moon Bay,CA 9 019 Milpitas, CA 95035Manteca,CA 95336 <br /> Phone(925)458-9800 Phone (650)726-1419 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(925) 458-9891 Pax(6501726-9183 Fax (408) 262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> TMAENERATO <br /> WASTE ACCEPTANCE NO <br /> ILING ADDRESSf,i , <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ` t m U ❑GLOVES LI GOGGLES 0 RESPIRATOR 0 HARD HAT <br />' PHONE ,. ,t� <br /> 'f f U TY VEK Q OTHER <br /> I—ECONTACT.PEFSQN p SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> Y �'P `,�t•.i`�`� �r`�- .tA ,,-m..�r"4j-�i' �; ✓ ,rti 5 n f r i; },.`' f ""wi�� tt"r 6t <br /> 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 condition for transportation&,cording to applicable <br /> regulators AND,It the waste is a treatment residue of a previously restricted hazardous waste <br /> subiact to the Land Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Pert 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Pan 2fi1 <br /> WASTE TYPE <br /> ❑DISPOSAL ❑SLUDGE <br /> 0 CONSTRUCTION El WOOD <br /> O DEBRIS Q OTHER <br /> ❑SPECIAL WAS'T'E <br /> GENERATING FACILITY <br /> TRANSPORTER <br /> '{ NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> py <br /> ADDRESS Y �t (� <br /> CITY, STATE, ZIP <br /> .�. _r.7 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> z, .� 3 <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> l t i ia' ❑ ❑ ❑ ❑ <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 /> DISPOSE OTHER <br /> U SOIL <br /> EMARKS <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> C3 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> r' r ❑WOOD <br /> Q ASH <br /> .� r <br /> r' 3 SPECIAL OTHER <br /> HEDUUNG MUST BE MADE PRIORTO 3 00 P M.THE DAY PRIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> O REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> TRANSPORTER COPY MANIFEST # 280924 <br /> 280 4 <br />