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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island 35Forward <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(9251458-9891 Fax(650) 726„9183 - Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILINGADDRESS _ <br />' F tJ <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> � '' y ❑GLOVES U GOGGLES U RESPIRATOR ❑HARD HAT <br /> PHONE <br /> 4.%..� Y'S_Z_ 32.(,tQ ❑TY VEIC a OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> 7/0 _7 <br /> GENERATOR'S CEFCr MAT10h I hereby testify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Pan 261 or title 22 of the Caldamia code of regulations,has been properly <br /> described classified and packaged and is in proper condition for transportation wcordmg to appifeable <br /> regulations AND,If the waste is a hve tmem residue of a praviouely restricted hazardous waste <br /> subject to the tend Disposal Restrictions I codify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 2613 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE Sit 1 C�+'L S <br /> U DISPOSAL U SLUDGE <br /> ❑CONSTRUCTION U WOOD <br /> U DEBRIS )R'OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> fly_ <br /> CITY, STATE, ZIP <br /> kcJ - 5 3 S`1 <br /> PHONE X END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED ENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> 51 <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 /> ❑ 501L <br /> REMARKS <br /> CI CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> / ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT f' DATE I U WOOD <br /> ❑ASH <br /> ❑ SPECIAL OTHER <br /> SCVIEDULING MIDST BE MADE PRIORTO 3 W P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> 'TO'REPUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DRAY BEFORE <br /> MANIFEST#I :3 <br /> r+.^+ cr5 wrr�r�r`nav <br />