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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 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 /> GENEATOR _ t3 x WASTE ACCEPTANCE N0. <br /> a '�.ca 1 c 6- 'F"c� � <br /> MAILING ADDRESS ell 04(ZF0--f7 <br /> 3 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Q(GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> PHONE <br /> U TY VEK O OTHER <br /> CONTACT PERSON S Ir F 6 Gc �2z --60 3"0= SPECIAL HANDLING PROCEDURES <br /> I�r ca AIr� ,V r4t sal € �* <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE �� L <br /> GENERATOR'S CERTIFICATION I hereby certify that the above named material Is not a hazardous <br /> waste as datined by 40 CFR Part 281 or title 22 of the California code of regulations has been property <br /> described,classified and packaged,and is In proper condition for transportation axording to applicable <br /> regufadons,AND,If the wasw Is a trsahmnt residue at a proviausly restricted hazardous waste <br /> sutla r�e1 Disposal Restrictions I certify and warrent that the waste has been treated In RECEIVING FACILITY s <br /> requirements of 40 CFR Part 288 and Is no longer a hazardous waste as defined by <br /> 40 CFR Pan 281 <br /> WASTE TYPE <br /> ❑DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRISHER <br /> ❑ T <br /> ❑SPECIAL WASTE f t L <br /> GENERATING FACILITY <br /> TRANSPORTER O NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY, STATE,ZIP <br /> PHONE ' END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OFAUTHORIZED ENT OR DRIVER DATEROLL-OFFS FLAT-BED VAN DRUMS <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 /> DISPOSE OTHER <br /> EMARKS ❑SOIL <br /> ❑CONSTRUCTION <br /> FACILITYTICKE7 NUMBER DEBRIS <br /> ❑NON-FRIABLE l� <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> O WOOD <br /> ❑ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 P M 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 N 38186 <br /> GENERATOR COPY J <br />