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U Keller Canyon ❑ il...Ml oLlntain [] Newby Isltre.sid D-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 /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> WASTE ACCEPTANCE N0. <br /> MAILING ADDRESS <br /> rf 1 " ,;;F -% : <br /> CITY, STATE,ZIP _ ' <br /> REQUfRED PERSONAL PROTECTIVE EQUIPMENT <br /> i <br /> Q GLOVES Q Q GOGGLES RESPIRATOR Q HARD HAT <br /> PHONE S ` � . <br /> Q TY-VEK Q OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I horeby codify that the above named malerla$is not a hazardous <br /> waste as defined by 40 CFR Pall 261 or title 22 of the Celilornia code of regulations,has been properly <br /> described,classified and packaged,and is in proper candlllon for transportation a-cordng to applicable <br /> regulations;AND,If the waste Is a treatment residue of a previously restricted hazardous waste <br /> sub�'eci tb it, <br /> Land Disposal Rostrielions,I certify and warrant that thhe waste has been healed in <br /> accordance wish the reguiromonis of 40 CFR Pert 266 and is no Eon er a hazardous waste as defined by RECEIVING FACILITY <br /> 40 CFR Pad 267. <br /> WASTE TYPE: <br /> Q'DISPOSAL Q SLUDGE <br /> O CONSTRUCTION ❑WOOD <br /> ❑DEBRIS Q OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER _ NOTES: VEHICLE LICENSENUMBER TRUCK NUMBER <br /> ADUBEss <br /> CITY„5 ATE, FP <br /> PHO E <br /> ._ . END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AU T HORIZED AGENT ORDRIVER DATE <br /> ROTC OFFS FLAT 8ED VAN DRUMS <br /> Ll Q <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 <br /> IS true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> EMARKS Q SOIL <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> Q WOOD <br /> Q ASH <br /> Q SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:W P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED.WITH THE LANDFILL THE DAY BEFORE. <br /> MANIFEST#t - '"' � .t' <br />