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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)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 /> NUN-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. , ,� <br /> MAILING ADDRESS ,� ! <br /> CITY, STATE,ZIP REQUIRED PERSONAL.PROTECTIVE EQUIPMENT <br /> c � <br /> PHONE r 0 GLOVES O GOGGLES D RESPIRATOR HARD HAT <br /> U TY-VEK G]OTHER <br /> CONTACTPERSON <br /> r SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AG Y, ITLE DATE <br /> b <br /> GEN rOR 5 CEICATION [he, y certify trial' o above named materrai is not a Hazardous <br /> defined by GFR Part 281 drope <br /> le 22 of tris afitomia code of regulations has been prly <br /> de Gassii rid pad-god a is in proper condition for transportation a coding to applocable <br /> roguiabarts AND, the waste Is a t tment residue of a Previousty restricted hazardous wase <br /> subpet!to the La DzsPosal Resiricti s I codify and warrant that the waste has bean treated in RECEIVING FACILITY <br /> atmrdance with a requirements of 40 CFR Part 268 and ism longer a hazardous waste as Winedby <br /> 40C Part 26 <br /> WASTE TYPE <br /> •DISPOSAL ❑SLUDGE ')V'J,,' 69 A w-z;t Ln Rd. <br /> • <br /> d- <br /> o CONSTRUCTION ❑WOOD V x.1, �� <br /> 0 DEBRIS U OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> 011 , <br /> ADDREss �' _ <br /> 0. Box 307 <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> _t.115f J0 6-6 !r? <br /> USIGNATURE,0F,AUTHORIZEDAGENTORDRIVER DATE ROLL-OFFS FLATBED VAN DRUMS <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 DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate <br /> DISPOSE OTHER <br /> EMARKS 0 SOIL <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT r �! ASBESTOS <br /> DATE <br /> ^ 1t 0 WOOD <br /> i <br /> "D- 1 <br /> ❑ASH <br /> ❑SPECIAL OTHER <br /> H DOLING MUS BE MADEPRI0RT0 3,0DP M THE DAY PRIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> Rk U AL UPON A iMlVA- L ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> TRANSPORTER COPY MANIFEST# 2 8 0 8 g l <br />