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p Keller Canyon 0 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 /> GENERATOR c 0 Y_ + Cc, WASTE ACCEPTANCE NO. <br /> A rt1 r C C 1--5 <br /> MAILING AD/DRESSLd <br /> CITY, STATE,ZIP _ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE <br /> 7 '' �`VX 2 4z 1 GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> U TY VEK 3 OTHER <br /> CONTACT PERSON :r-Fr 60._"'3310 SPECIAL HANDLING PROCEDURES <br /> 147 eA,'V t,rbc o,V14 r =. s i/t["le _ _ _ <br /> SIGNATURE OF AUTHORIZED AGENT TITLE DATE U �f �-f ltd f / t-� r L <br /> !^' <br /> GENERATOR'S CERTIFICATION I hereby owiffy that the above named material is not a hazardous <br /> W <br /> aste as defined by 40 GFA Part 261 or tide 22 of the California code of regulations,has been property <br /> described,classified and packaged and is in proper condition for tranaportallon as-eordrng to applicable <br /> regulations AND,It the waste in a treatment residue of a previously rssuloted hazamous waste <br /> subject to the Land Disposal Restrictions I certlly and warrant that the waste has been treated in RECEIVING FACILITY L C! <br /> accordance with the requirements of 40 CFR Part 266 and to no longer a hazardous waste as defined b1 / ' ! <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ❑DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑ THER <br /> ❑SPECIAL WASTE &Id +� <br /> GENERATING FACILITY ! dt— .! <br /> TRANSPORTER ,, i ;f o „ !�,j 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 be"; <br /> accepted and to the best of my knowledge the forleguingF <br /> is true and accurate. DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> J' <br /> DISPOSE OTHER <br /> REMARKS U SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT, DATE <br /> r ❑WOOD <br /> ❑ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 P M THE DAY PRIORTO EXPECTED ARRIVAL G ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> MANIFEST# C'; 4 4:,a' <br /> r,P:NFRArOR COPY <br />