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❑ Ke#ier Canyon ❑ Ox Mountain p 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(2092 <br /> Fax(925) 458-9891 Fax(650) 726-9183 Fax(408) 262-2871 Fax(209)90 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR �'1 r+/f Z' ' " <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS_r ,f'`� <br /> CITY, STATE, ZIP 'Y r�; ,' re _ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE D GLOVES 0 GOGGLES D RESPIRATOR ❑HARD HAT <br /> ❑TY-VEK 0 OTHER <br /> CONTACT PERSON `�� �f' �" � x'"•`k- SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATORS CERTIFICATION I hereby certify that the above named material is not ahazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations has been properly <br /> described ciassihed and packaged and Is in proper condition for transportation a-cording to applicable <br /> regulations AND,IF the waste is a treatment residua of s previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions I cerbiy 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 CFR Part 261 <br /> WASTE TYPE <br /> 0 DISPOSAL _ O SLUDGE <br /> D CONSTRUCTION D WOOD <br /> D DEBRIS 01-OTHER <br /> D SPECIAL WASTE f <br /> GENERATING FACILITY <br /> TRANSPORTER rZ NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS z DC7~ rr �rlr r•' ff ` <br /> CITY STATE,ZIP <br /> PHONE END DUMP` BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVgR DATE ROLL-OFF(S) FLAT-BEAD VAN DRUMS <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 /> REMARKS Q SOIL <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> s ,_ Q NON-FRIABLE <br /> SIGNATURE OFAUTHOR IZED GENT DATE ASBESTOS <br /> ( Q WOOD <br /> TO ASF f' <br /> _ s _ <br /> Q SP AL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 PM THE DAY PRIORTO EXPECTIEr15 ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJE <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFOR <br /> MANIFEST# CZ R > 9 9 <br />