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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)982-429 <br /> Fax (925)458-9891 Fax(650) 726-9183 Fax(408) 262-2871 Fax (209) 982_1 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR 11 1 r- __:�l <br /> r - WASTE ACCEPTANCE N0. <br /> _ r � l L i l t r .. <br /> MAILING AppRESS, r <br /> CITY, WATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ")a L f `' <br /> PHONE El GLOVES ❑GOGGLES 0 RESPIRATOR HARD HAT <br /> r <br /> " } s a TY-VEK ©OTHER <br /> CONTACT PERSON <br /> e I F - a SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE .D�yArTE <br /> GENERATOR 5 CERTIFICATION I hereby cede that the above named rnatenal is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulactons has been properly <br /> described classified and packaged and is in proper condition for transportation a-cording to applicable <br /> regulations ANC,It the waste is a treatment residue of a previously restricted hazardous waste <br /> subject 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 Part 268 and is no longer a hazardous waste as defined by <br /> 40 GFR Part 261 Forwni rd LrLaof 111 <br /> WASTE TYPE <br /> ❑DISPOSAL C]SLUDGE <br /> •CONSTRUCTION OWOOD ' sig L x, P <br /> ❑DEBRIS U OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> X173 f3C).Y`Pe o x 7 C;» ,q p _ <br /> AD KESS _ G� 1I `j <br /> 7.�, <br /> CI SITE, IP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> f� ❑ <br /> r r <br /> 1 F <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 /> EMARKS ❑ SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> SIGNATURE OFAUTHORIZED AGENT DATE ASBESTOS <br /> - < ❑WOOD <br /> F <br /> Q ASH <br /> 0 SPECIAL OTHER <br /> SCHEDULING MUST BE MADS PRI4RT0 3.00 P M.THE DAY PRIOR TO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> TRANSPORTER COPY MANIFEST# 20 2 5) <br />