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❑ Keller Canyon L] Ox Mountain ❑ Newby Island ❑ Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 Sah 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 /> GENERATOR WASTE ACCEPTANCE NO, <br /> MAILING ADDRESS <br /> CITY, STATE,ZIP _ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 1721s A GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> PHONE <br /> ❑TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> f H V,f !Jk15 f_T E r� 4�[ SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT I TITLE DATE <br /> GENERATOR s dEpR r1FICAT1oN I hereby certify that the above named malarial w not a hazardous <br /> waste as <br /> def€ned by 40 CFR Parl 261 or tide 22 of the California code of regulations has been properly <br /> described classified and packaged and is In proper condition for transportation a-carding to applicable <br /> regulations AND,If the waste Is a treatment residue at a previously restricted hazardous weals <br /> subject to the Land Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY { <br /> accordance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by - <br /> 40 GFR Pert 261 <br /> WASTE TYPE <br /> O DISPOSAL 0 SLUDGE I <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE �.._.- A' L <br /> GENERATING FACILITY " a , <br /> 07- y� <br /> P ,14 CY <br /> TRANSPORTER /�, -'" r-r ;��a'r �c NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <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 /> 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 /> ❑SOIL <br /> MARKS <br /> ❑CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER ❑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*ANY UNSCHEDULED LOADS ARE SUBJEQT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFOF€E <br /> MANIFEST N t <br /> GENLRATOR COPY <br />