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Li Keller canyon U 0 fountain ["l Newby Iala,...,,, [] Forward <br /> Sanitary Landfill Sarnxary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Rodd 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) 45B-980,0 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)982-1 G09 <br /> NON-HAZARDOUS WASTE MANIF=EST <br /> GENERATOR j <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS -- <br /> OTY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE <br /> U GLOVES U GOGGLES U RESPIRATOR CI HARD HAT <br /> ❑TY-VEK O OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENER(+TOR'S CERTIFICATION:i hereby comity that the above named malarial is'nol a hazardous <br /> waste es defined by 40 CFR Part 261 or tide 22 of the California code of regulations,has been property <br /> described,classified and packaged,and is in proper condition for transportation a^cording to applicable <br /> regulations;AND,if the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,1 cerlity and warrant that the waste has been ireated 1^ RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> U-DISPOSAL 0 5LUDGE <br /> U CONSTRUCTION U WOOD <br /> *DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY - — <br /> i <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ��, .:��' ,y •'�;fsj� ,fir <br /> ADDRESS <br /> CITY,STATE, ZIP._ _. . <br /> PHONE ENDDUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ <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 /> U <br /> EMARKS SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHOR IZED.AGENT DATE <br /> Q WOOD <br /> O ASH <br /> r. .. <br /> 'r ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 8:40 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* '° <br /> G6VFwRA'I_0R(:(:)PY <br />