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1 - <br /> ' ❑ Keller Canyon E]-Ox Mountain ❑ Newby Island ❑ Forward <br /> SianitarrLandfill Sanitary L=andflfl 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) 982-4298 <br /> Fax(925)458-9891 Fax(650) 726-9183 4 Fax (408)262-2871 Fax (209)982-1009 <br /> NON-HAZOMOUS` VASTE MANIFEST <br /> GENERATOR-6 <br /> WASTE ACCEPTANCE NO. r <br /> ' MAILING ADDRESS I <br /> CITY, STATE, ZIP ; REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Y-✓ �I f s t f tf •�-.�— <br /> ' PHONE � t ©GLOVES ❑GOGGLES ❑ RESPIRATOR ©HARD NAT <br /> ❑TY VEK ' ❑OTHER <br /> CONTACT PERSON ,r, 1 _ <br /> SPECIAL HANDLING PROCEDURES <br /> ' SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> ' GENERATOR S CERTIFICATION I hereby certify that the above nand material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or We 22 of the Calrfomra code of regulations has been property <br /> described classified and packaged and is in proper eandihon for transportation a-cord ng to applicable <br /> regulations AND If the waste Is a treatment residue of a previously restricted hazardous waste <br /> ' ' biect to the Land Disposal Restnchons I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requrraments of 40 CFR Pan 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> Q DISPOSAL 0 SLUDGE <br /> 0 CONSTRUCTION 0 WOOD <br /> 0 DEBRIS HER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS ` t, 2i <br /> CITY,STATE,ZIP r 3 <br /> L , <br /> a <br /> ' PHONE r r E 4 . END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> ' SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROL r-OFF(S) FLAT-BED VAN DRUMS <br /> ❑ (j Ll Ll <br /> f <br /> -71. f{1 # <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 /> a <br /> DISPOSE OTHER <br /> 0 SOIL <br /> REMARKS 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> 0 NON FRIABLE <br /> ASBESTOS <br /> SIGNATURE AUT ORIZEO AGENT DATE <br /> �t 0 WOOD <br /> 0 ASH <br /> ❑ SPECIAL OTHER <br /> ' SCHEDULING MUST BE MADE PRIORT0 3 tin PM THE DAY PRIORTO 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 /> MANIFEST#t �, t"i e>°I °� <br />