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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island ><Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary LandfillLandfill <br /> 901'Bailey Road 12310 San Mateo Road ` 11 661 Dixon Landing Road 9999 S.Austin Road <br /> P,ittsburo,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)456-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> r�l NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS20 <br /> J _ <br /> CITY, STAT 'ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE LOVES ❑GOGGLES O RESPIRATOR ARD HAT <br /> ❑TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHOMIrED AGENT/TITLE DATE <br /> �--- /men r <br /> * f` <br /> GENERATOR'S CERnFICATION:I hereby cw1ity that the above named material Is not a hazardous'. <br /> waste as defined by 40 CFR Part 281 or lift 22 of the Cafiforrmia code of regulations,::been properly <br /> dssalb6d,ct4sHied and packaged,and is in proper condition for transportation according to applicable <br /> regulations:ANq if dw waste Is a bambnerd reside at•previously reabimed hazardous waste <br /> sumeei to rhe t and 64osal Restrictions.I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and Is no longer a hazardous waste as defined by <br /> 40 CFR Part 281. <br /> WASTE TYPE: - <br /> WISPOSAL ❑SLUDGE <br /> 'O CONSTRUCTION O WOOD <br /> O DEBRIS O OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> OXRAN@sjpbRTER NOTES: VEHICLE LICENSE NUMBER ..�TPU NUMBER <br /> ADDRM <br /> ATE, I <br /> - i <br /> PHONE— END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF-AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> A dA 04143202 . <br /> 1�0 <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 /> EMARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE' <br /> ❑WOOD <br /> ❑ASH <br /> 7k ! a SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THE DA .RIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> MANIFESTS 389'56 <br /> 'GENERATOR COPY <br />