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❑ Keller Canyon ❑ Ox Mountain ❑ 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 Halt 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 /> �r �Fa3c(925)45Q,-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209) 982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR :: + f 1 I- WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY, STATE,ZIP _ REQUIRED PERSONAL PROTECTIVE EQUIPMENT � <br /> w r " j L { ' y ` f W GLOVES U GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> PHONE <br /> Q TY VEK L1 OTHER <br /> CONTACT PERSON ' <br /> r U�'rd}f j9: 1"7,-,4 t J �7 V,� ,x SPECIAL HANDLING PROCEDURES r - <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE r� r'�c p {' `��• = - �- <br /> GENERATOR S CERTIFICATION I hereby cart€ly that the above named material os not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations has been property <br /> described classified and packaged and is in proper condition for transportation a wrt ing to applicable <br /> regulations AND,H the waste is a treatment residua of a previously restricted hamrdous waste <br /> subject to the Land Disposal Restrictions I certify and warrant that the waste has been treated in � <br /> RECEIVING FACILITY ' •'' P <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by P <br /> 40 CFR Part 261 <br /> U <br /> ETYPE <br /> DISPOSAL Q SLUDGE <br /> CONSTRUCTION Ql WOOD <br /> DEBRIS ❑OTHER <br /> SPECIAL WASTE A 5,�`jRATING FACILITY <br /> TRANSPORTER OTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY, STATE, ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATUR F AUTHORIZED GENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to the beat of my knowledge the foregoing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate <br /> DISPOSE OTHER <br /> EMARKS ❑SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> w <br /> SIGNATUR=OF AUTHORIZED AGENT,-' DATE ASBESTOS <br /> ❑WOOD <br /> / <br /> f ,r ` ' o ASH <br /> `r <br /> ❑SPECIAL OTHER <br /> 1 <br /> SCHEDULING MUST BE MADE PRIOR TO 3 00 P M THE DAY PRIOR TO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON AMRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> Y MANIFEST <br /> roc*cn nrno/`YIOV <br />