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❑ Keller Canyon ❑ ox mountain LJ Ivewuy Isianu ,ail FulWC11u ; <br /> Sanitary Landfill Sa-'+ary Landfill Sanitary Lr— fill Landfill <br /> 901'Bailey Road 1?&_.o-an Mateo Road 1601 Dixon La�., j Road 9999 S.Austin Road <br /> Pittsburg,CA 94565 — Halt 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 s <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�4[)DRES <br /> CITY,STATE,ZlP' REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 4 r . _. - ---- ❑GLOVES ❑GOGGLES ❑RESPIRATORHARD HAT <br /> PHO'IcIE <br /> ❑TY-VEK OOTHER <br /> CONTAer PERSON �`'• SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE O AUTHORIZED AGENT/TITLE DATE. f <br /> t C <br /> GEN&ATORB CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property <br /> described,classified and packaged,and is in proper condition for transportation a cording to applicable <br /> regulations;AND.If the waste Is a treatment residue of a previously restricted hazardous waste <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 /> - O CFR Part 261.-� cw., _. _ ,,, _ �! ,,•- , .t/�Y .,:.e` <br /> WASTE TYPE: <br /> .0 DISPOSAL �r t f El SLUDGE <br /> ❑CONSTRUCTION O WOOD <br /> U DEBRIS -OTHERf <br /> SPECIAL WASTE r <br /> ❑ e e 1 <br /> GENERATING FACILITY,•; Lk <br /> r.a. <br /> fRANSPORTE i \ ':� l �F NOTES: VEHICLELICENSE.NUMBER TRUCK UMBER <br /> ESS / u " �`'� �_' _ <br /> 1 r <br /> STATE,ZIP'.E .`; s Y n_ 1 I 'C.� m t�r `- + _ - - _-END_DU P`__--_—B0-TTOMDUMP---- TRANSFER -- <br /> SIGNATURE-OF AUTHORIZED AGENT,OR DRIVER DATE ROLL'-OFFS) FLAT-BED. VAN DRUMS <br /> CUBIC YARDS <br /> 1-hereby certify that the above named'materlaf has been <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD: . (TO BE-COMPLETED BY LANDFILL) <br /> 1 <br /> is true and accurate. DISPOSE' OTHER <br /> U SOIL . <br /> EMARKS ❑CONSTRUCTION <br /> ,'..,. <br /> FACILITY TICKET NUMBER . _ :, DEBRIS 1 . i <br /> G NON-FRIABLE <br /> f_. .;.: .. ASBESTOS r_ <br /> SIGNATURE OF AUTHORIZED AGENT " DATE C] -¢�: <br /> WOOD ��sr <br /> J•'� � �� 3 +° '� / f' U ASH <br /> 0 SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDOLED LOADS ARE SUBJI=CT <br /> TO-REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> TRANSPOIRTER COPY MAN IF 444"702 <br /> I <br />