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❑ Keller Canyon �❑ Ox Mountain ?❑,Newby Island ~ ❑ Formed W <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)982-4298 <br /> 0 Fax (925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> WASTE ACCEPTANCE NO. <br /> MAIL INC3 Walnut Street -. # .3212 <br /> CITY, S REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONEBOIS399 <br /> U GLOVES 4 GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> CONTAQ%VjO TY-VEK ❑OTHER <br /> SPECIAL_HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT TITLE DATE <br /> GEN ATOR S CERTIFICATION I hereby cerlrly that the above named matensl na not a hazardous <br /> w a as defined by 40 CFR Part 261 or We 22 of the Cardomns <br /> ta code of regulatio ,has been properly <br /> described classified and packaged and is in Proper condNon for transportation avorrfing to applicable <br /> regulations AND,If the waste is a treatment reeldue of a previously restricted hazardous westo <br /> subject to the Land Disposal Restnetions I certify and warrant that the waste has been treated In RECEIVING FACILITY <br /> accordance with We 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 /> ..1 DISPOSAL ❑SLUDGE <br /> CONSTRUCTION ❑WOOD <br /> �J DEBRIS ❑OTHER <br /> ZI SPECIAL WASTE <br /> GENERAT41G,EACILlTY_, ,,, <br /> r eA 9:7di1.7 <br /> TRANS NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRES�jn.. I •r f 4/ ,V t <br /> CITY, STATE,ZIP­11,71 MY <br /> ' <br /> CA 95828 <br /> PHONE <br /> D 381 4j864 END DUMP BOTTOM DUMP TRANSFER <br /> Cr <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATEU <br /> ROLL-OFFS FLAT-BED VAN DRUMS <br /> * , a3.�3 ❑ ❑ L1 ❑ <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been '18 Yards <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 U SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AG ENTDATE ASBESTOS <br /> U WOOD <br /> * ❑ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3 00 P M THE DAY PRIOR TO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST M <br />