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Lt Keller Canyon ❑ Ch-Mountain i] Newby Islas <br /> Sanitary Landfill Sanitary Landfill Sanitary0 Forward <br /> 901 Bailey Road 12310 San Mateo Road �.e�l'ICIfiII Landfill <br /> Pittsburg,GA 94565 1601 Dixon Landing Road 9999 S.Austin Road <br /> Phone (925) 9456 00 Half Moon Bay, CA 94019 Milpitas,CA 95035 <br /> Fax(925) 5)45 891 Phone (650) 726-1819 Phone(408}945-2800 Manteca,CA 95338 <br /> Fax(650) 726-9183 Phone (209)982-4296 <br /> Fax(408)262-2871 Fax (209)992-1009 <br /> GENERATOR <br /> NON-HAZARDOUS WASTE MANIFEST <br /> _ <br /> ` LING WASTE ACCEPTANCE NO. <br /> MAIADDRESS <br /> REQUIREmY PERSONAL PROTECTIVE EQI IIPMENT <br /> --- <br /> ❑GLOVES Q GOGGLES O RESPIRATOR O HARP HAT <br /> CONTACT PERSON' o TY-VEK Q OTHER <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE SPECIAL HANDLING PROCEDURES: <br /> - DATE <br /> GENERATOR'S CEFl1*lCAT10N:I hereby certity that the above named malarial Isnot a hezardous <br /> waste as defined by 40 CFA Part 26t or tills 22 of the Caarornis coda operty, <br /> of regulations,has been pr <br /> described,classiried and packaged,and is in proper condition for Iransportation a^cordinq la applicable <br /> regulations.AND,if the waste 72 a trssimeht residua of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,i certify and warrant that the wasla has been treated in <br /> socordance with 171e requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by RECEIVING FACILITY <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> QZ61POSAL U SLUDGE <br /> Q CONSTRUCTION U WOOD <br /> Q DEBRIS 0 OTHER <br /> b SPECIAL WASTE <br /> GENERATING FACILITY <br /> RANSPORTER <br /> NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY, TATE,ZI " <br /> END DUMP BOTTOM DUMP TRANSFER <br /> 136011M 1 URE OF ALJT ORIZED AU ENT OR DRIVER DATEL] <br /> ROLL-OFF(S) FLAT BED VAN DRUMS <br /> Lj <br /> GUBIG YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to the best of trey knowledge the foregoing <br /> is true and accurate. DISPOSAL METHOD_ (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> EMARKS Q SOIL <br /> FACILITY TICKET NUMBER Q CONSTRUCTIONEI <br /> t a' 0 NON-FRIABLE <br /> SIGNATURE L)t AUTyORtZED-" T DATE ASBESTOS <br /> Q-WOOD <br /> `r/t7 ASH <br /> U SPECIAL OTHER <br /> DCHEDULING MAST BE MADE PRIORTO 3:00 P,M.T'HE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> 'O REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> MANIFEST# - a <br />