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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 Halt Moon Bay,CA 94019 Milpitas, CA 95035 Manteca,CA 95336 <br /> Phone (925)458-9800 Phone (650)!26-1819 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 /> 2GENERATOR _ WASTE ACCEPTANCE NO <br /> MAILING ADDRESS <br /> 9 L VLN + ' � <br /> CITY, STAT,ZIP REQUIRED PERSONAL PROTECTIVff EQUIPMENT <br /> ❑GLOVES U GOGGLES ❑RESPIRATOR )b HARD HAT <br /> PHONE <br /> Q TY VEK ❑OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> 0 � <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> *p' <br /> GENERATORS CERTIFICATION I hereby certify thltt the above named material Is not a hazardous <br /> waste as defined by 40 CFR Part 261 or We 22 of the Califoma code of regulations has been property <br /> described Classified and packaged and is in proper condition for transportation a cording to applicable <br /> regulations ANG,If the waste Is a treatment residue at a previously restrtoted hasardous waste <br /> subletl 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 Pars 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Pad 265 r. .fW e r -, .fit ul Z- 1 <br /> WASTE TYPE 4 a1 /wF iJ ry T yw 4 d } U <br /> ❑DISPOSAL ❑SLUDGE <br /> O CONSTRUCTION ❑WOOD <br /> ❑DEBRIS U OTHER <br /> •SPECIAL WASTE <br /> GENERATING FACILITY <br /> .I <br /> TR SP�" ER v NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> I�It ' r .y <br /> ADDRESS <br /> e <br /> t. 1-1 I.M z3_ <br /> CITY, STATE,ZIP <br /> ENQ,DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> { (, ❑ ❑ ❑ ❑ <br /> r !/ <br /> CUBIC YARDS <br /> hereby certify that the above named material has been <br /> accepted and to the best of my knowledge tate foregoing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL.) <br /> Is true and accurate <br /> DISPOSE OTHER <br /> ❑SOIL <br /> EMARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ASBESTOS TOS <br /> ASBE <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> � ❑WOOD <br /> O ASH <br /> f ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE 14ADE PRIORTO 3.00 P M THE DAY PRION 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# 280326% <br /> 2803 6 <br />