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uL <br /> - l246AMy i ronmentalNo.J Keller canyon Ej ntain Li Newby WE -VForward <br /> Sanitary Landfill "'mountain <br /> Landfill Sanitary LaWdfill Landfill <br /> 90f Bailey Road 12310 San Mates Road 1601 Dixon Landing Road 9999 S_Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay,CA 94019 Milpitas,CA 95095 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(6$0)726-1819 Phone(408)945-2800 Phone(209)982.4298 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING DD S _ <br /> VA <br /> C S IP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHO O GLOVES ❑GOGGLES Q RESPIRATOR HARD HAT <br /> Q TY VEK ❑OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGRATURE OF AUTHORIZED AGENT/TITLE DATE <br /> r <br /> GENEPATOR'S CE rnFicAmON;I hwaby oar*dw 1tq named material is not a harardaro <br /> waste m defined by 40 CFR Pam 287 w Vtk.22 gf the Cardgmia coda of r*gWg6gna,hag bean properly <br /> oeaamed,CFaeaalaa and peckaoK ens a in propw eomfton for trartaportafion axardmp toappticahle <br /> reg Meana:AND,tI tM waste Is a gent nm*ft a Of*pr erieuay reahbfsd huw49w waift <br /> xqad to <br /> rNmw+i Owmq*rrp eg*gf40 FR;°on2668wldisn WoraNaerrrddouu$wast`eaasddofinadby RECEIVING FACILITY - <br /> 40 CFR Part 261, - <br /> WASTE TYPE: <br /> POSAL 0SLUDGE <br /> CONSTRUCTION O WOOD <br /> 0 DEBRIS 0 OTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY_ _ --- <br /> TFiANSPORTE NOTES: VEHICLE=LICENSE NUtu18ER TRUCK NUMBER <br /> ADDRESS <br /> CITY,STATE,ZIP 7' V! U <br /> PHONE 3 ENI D DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accented 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 /> FtEMCI sprL <br /> ARKS <br /> 0 CONSTRUCTION <br /> FACILITY TICKETDEBRIS NUMBER 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> O ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIORTO 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 k F;17!P 7 <br />