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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 <br /> Fax(925)458-98£' Fax(650) 726-9183 Fax(408) 262-2871 Fax(209)982-1 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR ✓ 7 7 ; , 2 ,- <br /> w WASTE ACCEPTANCE NO <br /> MAILING ADDRESSCJ <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE E UIPMENT <br /> r� <br /> PHONE J — "„� ire U GLOVES 0 GOGGLES ❑RESPIRATOR @ HARD HAT <br /> C]TY-VEK O OTHER <br /> CONTACT PERSON ,_..._- <br /> �,:- SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF. ITLE / DATE <br /> I !! f <br /> �0 1 <br /> / .,/ <br /> t'lE R!TbR S RTIFICATI©N hTAb'y ea [het the shove named material is not a h�zardaua{ <br /> Viola define y 40 GFR Pah 11 or hila 22 dt the California code of regulations has been properly <br /> Gastied and packaged and is in proper condition for transportation a-cord5ng to applicable <br /> t r9gutations At If the waste 14;e treatment residue of a previously restricted hazardous waste <br /> Subject to the Land Disposal Retltrlcdons l cehrty,and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance 1h the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined try <br /> 40 CFR Part6f <br /> WASTE WPE <br /> ,1 DISPOSAL Z1 SLUDGE i1'3r19 All zi ;2 Cr <br /> D CONSTRUCTION ❑WOOD s°. P k k�,�,rC4 o� '66 <br /> ❑DEBRIS U OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> AD ES <br /> • i � ,ysnM <br /> CITY, STATE,ZIP <br /> 9A <br /> PHONE <br /> 1 ` o END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-Off(S) <br /> FLAT-BED <br /> VAN DRUMS <br /> 7k 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 <br /> Is (TO BE COMPLETED BY LANDFILL) <br /> s true and accurate <br /> f} DISPOSE OTHER <br /> EMARKS '� ❑SOIL <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER J , Q,7 DEBRIS <br /> a NON-FRIABLE <br /> SIGNATURE OFAUTHORIZEDAGEN'{ DATE ASBESTOS <br /> 7 i ❑ WOOD <br /> t ❑ ASH <br /> ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 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# 9 Q f) Q Q P <br />