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p Keller Canyon ❑ Or Mountain ❑ Newby island ❑ Forward <br /> Sarilitary Landfill Si ..tary Landfill Sanitary h,.Afiil 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 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILIN. ADDRESS _ <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 0 GLOVES O GOGGLES ❑RESPIRATOR O HARD HAT <br /> PHONE <br /> U TY VEK O OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE. F AUTHORIZED AGENT/TITLE DATE <br /> "AOOV Cfoks cERnFicAT ons I hereby mw that the above named material Is not a hazardous <br /> veleta w dslrsd by 40 CFR Part 281 or We 22 of the California code of regulations,has been properly <br /> paatbed,dessNad and packaged,and Is in proper condition for transportation a.= ng b appNcable <br /> h9liletio s;AM If the waste N a OvabnaM reslrtrle of a prsvbusiy rso la lad lasadow waste <br /> subject to the Land Disposal Restrictions,I tarty and wwmm that the waste has been boated in RECEIVING FACILITY <br /> accordance wNh the recorements of 40 CFR Par 288 and is no longer a hazardous waste as detirsd by <br /> 40 CFR Par 281. <br /> WASTE TYPE: <br /> O DISPOSAL 4 SLUDGE <br /> O CONSTRUCTION ❑WOOD <br /> O DEBRIS O OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> (iC+! U lit, liti•t+f r':F '�rockfori; ._r? <br /> TRANSPORTER NOTES: VEHICLE ICENSE NUMBER TRUCK NUMBER <br /> A' fni;vy � <br /> '.k Sons..,t l.a T(t.ir k1T1r:)., in,r <br /> ADDRESS <br /> :.i0 La�.� f Lsit'.t3r;. I[L1. <br /> CITY,STATE,ZIP <br /> PHONE ., END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURF OFAUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> 1 hereby certify that the above named material has been 091AYriS <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 ❑SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIONATURE OF AUTHORIZED AGENT DATE <br /> + 0 WOOD <br /> t �r �• t' i f, . 3lif t{��`r' + r 1�t: i ❑ASH <br /> 6 r 9! 1 <br /> L SPECIAL OTHER <br /> SCHEID)JUNd MUST BE A*PRIORTO 3:00 RKTHE DAY PRIORTO 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 /> TRANSPORTER COPY MANIFEST# ', <br />