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L1 Keller Canyon ❑ ",-Mountain, <br /> ❑ NewbyI,' �d <br /> ys;; �� Sanitary Landfill Forward <br /> ` Itary Landfill Sanitaryndfill. ` Landfill <br /> 901 Pittsburg, Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> burg,CA 94565 Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(650)726-1819 Phone(408)945-2804 Phone(209)982-4298 <br /> Fax(925)458-9891,... Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1003 <br /> ;i <br /> ,. < NON-HAZARDOUS WASTE MANIFEST <br /> GENERATORV AtWASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> 2S91 - # <br /> CITY,STATE,ZIP a itREQUIRED PERSONAL PROTECJIVE EQUIPMENT- <br /> PHONE ': C(GLOVES .►[�CU OGGLES ❑RESPIRITdR'c' ❑HARD HAT " <br /> o TY-VEKfl'OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIG NAT, RE OF AWHORIZED A NT/TITLEJ DATE <br /> * Z� 0� <br /> GE ER 4TQR'S CERTIFlCATIO .E' certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Pa 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;AN%If the waste is a treatment residue of a previously restricted houtrdous waste i <br /> sutryed 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 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: T <br /> ❑DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> •DEBRIS BOTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY , <br /> TRANSPORTER i9grnutt j!, , itl s,i NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS 17H u lA4A I ki <br /> .i <br /> CITY, STATE,ZIP r <br /> PHONE _c END DUMP BOTTOM DUMP' TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER . DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ <br /> - <br /> n . <br /> N. V� CUBIC YARDS <br /> I hereby certify that the above-named material has been <br /> accepted and to the best of my knowledge the foregoing <br /> DISPOSALYE OD (TO BE COMPLETED BY LANDFILL <br /> _ Is true and accurate. 3-.. I }s _- <br /> DISPOSE OTHER <br /> REMARKS 0 SOIL <br /> ;i ID CONSTRUCTION <br /> FACILITYTICKET NUMBER °i DEBRIS <br /> j ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AU ORIZED AGENT DATE <br /> ❑WOOD . <br /> f ' l it ❑ASH l <br /> , ra SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT w <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE <br /> QDAY BEFORE. <br /> MANIFEST#. D V - h <br /> GENERATOR COPY <br />