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10 Keller Canyon ElOx,"aountain ElNewby talar-4 XForward <br /> � itary Landfill. :.,,. Sa��tiry LaL!�dlflll Salnitary L� 11 11 LandfIll <br /> •� 901 Bailey Road ,12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> "ittsbur� CA 94565 "Ralf 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 /> t NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS --� <br /> Clj ,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> O :GLOVES a GOGGLES U RESPIRATOR ,BARD HAT <br /> PHONE <br /> -'- <br /> - 5 - '715 Z -E-5 .a r U TY VEIL : O OTHER <br /> CON CT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> ;,n �% <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE " <br /> GENERATOR'S 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,N the waste Is a treatment residue of a previously restricted hazardous waste <br /> subiect to the Land Disposal Restrictions,I certity 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 GFR Part M, - - <br /> WASTE TYPE: <br /> Q(DISPOSAL U SLUDGE <br /> b CONSTRUCTION U'WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER' NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ATC <br /> ADDRESS <br /> CITY, STATE,ZIP <br /> e ( a� <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 74-- 2_2z ❑ ❑ ❑ <br /> SIGNATURE OFAUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) 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 /> REMARKS <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH <br /> / , /, !� U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PR1 RTO 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 /> MANIFEST# 38957 <br /> GES ERAT OR C 0 P Y <br />