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[� Keller Canyon [l M.Aountain J Newby Isiaiii+d n Forward <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(925)458-9891 Fax(650) 726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> k <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY,STATE, ZIP RI=QUIRED PERSONAL. PROTECTIVE EQUIPMENT <br /> ❑GLOVES Q GOGGLES G RESPIRATOR Q HARD HAT <br /> PHONE ' <br /> Q TY-VEK Q OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATORS C[RTIFICATIOR I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Pan 261 or Are 22 of the Cefilomsa code of rogulalions,has boon property <br /> described,class ifiad and packaged,and is in proper condition for transportalion a-cording 10 applicable <br /> regulations;AMD,It the waste Is or treatment residue of a prevlousfy restricted hazardous waste <br /> subiact to the land Disposal Restrictions,I certify and warrant that Iha waste has been treated In RECEIVING FACILITY <br /> accordance with the requ3remonls x140 CFR Part 260 and is no k"jer a hazardous waste as defined by <br /> 40 CFR Pad 261. <br /> WASTE TYPE: _ <br /> 37'15ISPOSAL Q SLUDGE <br /> Cl CONSTRUCTION O WOOD <br /> *DEBRIS ❑OTHER W <br /> SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS y a t <br /> .. ` ,_ <br /> CITY,STATE,ZIP - <br /> PHONE L::E!ND DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLATBED 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 /> EMARKS Q SOIL <br /> ❑ CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> f Q WOOD <br /> 0 ASH <br /> EEL `❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MADE P91OR TO 3:00 I?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 N '7+3 � <br /> TFv��J;�POR'fERGdPY .__ •�'..' <br />