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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island [ Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill r Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pitta4urg,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 Y 4 _ V WASTE ACCEPTANCE NO. <br /> z n <br /> MAILING ADDRESS <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 4' f 'i <br /> 5- ' T/L11 � 'f L 7k JM GLOVES 0 GOGGLES CI RESPIRATOR 0 HARD HAT <br /> PHONE <br /> ❑TY VEK 0 OTHER <br /> CONTACT PERSON,-T F <br /> 41 rr , 7' f, �, r` f , SPECIAL HANDLING PROCEDURES _ <br /> SIGNATURE OF AUTHORIZED AGENT TITLE DATE r- 4, �` � ' r} r <br /> GENERATOR S CERTIFICATION I hereby certdy that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or dde 22 of the California code of regulations has been properly <br /> described classified and packaged and is in proper condition for transportation arcording to applicable <br /> regulations AN%if the waste to a tisatment residua of a previously restricted hazardous waste <br /> auh]ect to the Land Disposal Restrictions I owtHy and warrant that the waste has been treated In RECEIVING FACILITY d s ? <br /> accordance with the requirements of 40 CFR Part 268 and Is no longer a hazardous waste as deflned by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> 0 DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION 0 WOOD <br /> 0 DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE ,-4 SP t <br /> GENERATING FACILITY 7 -r- C <br /> 5- <br /> 95 <br /> TRANSPORTER.�`j NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS (J J <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLLOFF S FLAT-BED VAN DRUMS <br /> h f <br /> ' I <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; <br /> Is true and accurate. DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> f 0 SOIL <br /> REMARKS f� <br /> r ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> © NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑WOOD <br /> ❑ASH <br /> ❑_SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 PM THE DAY PRIORTO EXPECTED ARRIVAL o ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE -: <br /> MANIFEST* 383-29 <br /> GF=W RATnPfYIPV .- <br />