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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)458-9891 FIX(650) 726-9183 Fax(408) 262-2871 Fax(209)982-1 <br /> k <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> WASTE ACCEPTANCE NO <br /> MAILING ADDRESS <br /> CITY, STATE,, ZIP - ,��� REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE J <br /> — QGLOVES 0 GOGGLES 0 RESPIRATORHARD HAT <br /> C3 TY-VEi( ❑OTHER <br /> CONTACT PERSON „-,.., + t��� �� <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF UTHORIZEDAGENT/TITLE DATE <br /> Im`oi]1 11 ,'T <br /> GEri TO SC RTIFICATION I herob ff certify that the above named material is not dhazardcfus <br /> w Is imdefined ry 40 CFR Part 261 or htte 22 of iiia California code of regulations has been properly <br /> do ad ciaasJPied and packaged sand is in propaf condition for transportation a-owdmg to applicable <br /> r@g(iilatrons AN If the waste is a treatment residue of s previously restricted hazardous waste <br /> subject to the lend Drsposaf Restrictions I certtV and warrant thal the waste has been treated In <br /> accordance with the requirements of'40 CFR P,9r1268 and is no longer a hazardous waste as defined by RECEIVING FACILITY <br /> 40 CFR Part 281 <br /> WASTE TYPE <br /> ©DISPOSAL ❑SLUDGE %'''')9,9 1 r' <br /> CI CONSTRUCTION QWOOD <br /> ❑DEBRIS Cl OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NoTEr VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> J i.e 3"E{ Z' E: 1.L s al lr✓'n �} ^7a <br /> ADDRESS L <br /> a t tf �.+ 9 <br /> CITY, STATE,ZIP <br /> PHONE ENQ DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VANDRUMS <br /> x � <br /> ` CUBIC YARDS <br /> I hereby certify thO 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 /> REMARKS 0 SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> SIG NATURE OF AUTHORIZED GENTs ASBESTOS <br /> DATE <br /> F ❑WOOD <br /> NXVs <br /> JE]ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORT0 3•©O RM THE 0 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 BEFOR9 <br /> TRANSPORTER COPY MANIFEST <br />