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❑ Keller Canyon ❑ Ox Mountain ❑ Newby IslandrForward <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 Moan 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 .�' 4 (_ 0 >" WASTE ACCEPTANCE NO. <br /> =A A.11 C 1 _ <br /> MAILING ADDRESS — f <br /> L J� <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> M1 GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> PHONE <br /> ❑TY VEK ❑OTHER <br /> CONTACT PERSON , `I� SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> -)O u <br /> GENERA R's CERTIFICATION I hereby oer*that the above named material Is not a hazanious 0 C d <br /> waste as deflned by 40 CFR Part 261 a title 22 of the California code of reguiattans hes been properiy <br /> described daesitied and packaged and is in proper eondition for transportation armwing to spoicabie <br /> regulations AND,It the waste Is a haafmsrd residua of a prswlously raatrbcted harardcus Waste s F# <br /> subject to the Lend Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY 6 (,4JX- <br /> acCordanee with the requirements of 40 CFR Part 268 and is no tonger a hazardous waste as defined by - <br /> 40 CFR Part 281 <br /> WASTE TYPE <br /> ❑DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑O ER <br /> ❑SPECIAL WASTE i <br /> GENERATING FACILITY CLO <br /> TRANSPORTER ` , NOTES I VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> { <br /> ADDRESS 21, <br /> CITY,STATE,ZIP <br /> - PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> I hereby certify that the above named material been <br /> accepted and to the best of my knowledge the f oing <br /> is true and accurate. <br /> DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> - <br /> rk DISPOSE OTHER <br /> �l <br /> ❑SOIL <br /> EMARKS ❑CONSTRUCTION <br /> I DEBRIS <br /> FACILITYTICKET NUMBER ❑NON-FRIABLE <br /> 4f ASBESTOS <br /> SIG"TORE OF NT DATE ❑WOOD <br /> ❑ASH <br /> i ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIG TO 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� BEFFORE <br /> MANIFESTS 3 8 L 8 8 <br />