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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island X 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 29891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NOthHAZARDOUS WASTE MANIFEST <br /> GENERATOR q- WASTE ACCEPTANCE N0. <br /> MAILING ADDRESS r�-rZ 0 Com- 7 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 5 7- A ' f ''L' �� b-GLOVES ❑GOGGLES ❑RESPIRATOR D HARD HAT <br /> PHONE <br /> ❑TY VEK ❑OTHER <br /> CONTACT PERSON '+ " : ✓ '_ o � SpEGIAL HANDLING PROCEDURES c— <br /> +a.�J1�t <br /> SIGNATURE OF AUTHORIZED AGENT!TITLE DATE �- ;� t i : r A <br /> l�'mt\ .._-•- ��� �� �� '� �'� � � � � S.J (J of y, <br /> L <br /> t <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> waste as denrted by 40 CFR Part 261 or We 22 of the California code of regulations has been property <br /> described classified and packaged and Is in proper condition for transportation according to applicable a ' <br /> regulations AND,if the waste Is a treatment rseidus of a previously restrtoted hazardous waste <br /> subject to the land Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY C41"-j12 f�"> <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as donned by <br /> 40 CPR Pail 261 <br /> WASTE TYPE <br /> ❑DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑QTHER <br /> C1 SPECIAL WASTE .S 61 L— <br /> GENERATING FACILITY .{ r X <br /> TRANSPORTE �` t` r ;� ,- NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE.Q 'AUTHORIZED AcIERT OR DRIVER DTE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> t f rf j./ 41 <br /> r <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to the nest of my knowledge the foregoing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> ❑ <br /> REMARKS solL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON–FRIABLE <br /> W ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT, DATE <br /> _ r <br /> ❑wooD <br /> ❑ASH <br /> r ❑ SPECIALOTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 P M THE 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 /> MANIFEST# Zt 9 0 <br /> GENERATOR COPY <br />