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ik <br /> :[] Keller Canyon 0 OL.Jountain <br /> Newby lsla [],.I brward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill <br /> Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> PdIsburng, 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 /> Pax(925) 458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209) 982.1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> ,-r- ,.;�, ;;} WASTE ACCEPTANCE NO. <br /> r: . - <br /> MAILING ADDRESS <br /> �:• {,Z' <br /> CITY,STATE,ZIP -REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE El GLOVES 0 GOGGCES_.. .q RESPIRATOR O HARD HAT <br /> < - j �_; �i ❑TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING-PROCEDURES, <br /> SIGNATURE OF AUTHORIZED AGENT/ ITLE DATE <br /> GENERATOR'S C,�ERiiFICATION:I hereby verily,that ilia nbove named materai is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the Callfornfa coda of regulations,has been properly <br /> describod,cla4sRied and pac%agod,and is in proper vondillon for iransportation a,cording to applicable <br /> regulalions;AND,If the waste is a treatment residue of a PrevlDusry restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I vanity and warrant that the waste has been boated in <br /> accordance with the requiromenis of 40 CFR Pad 268 and Is no longer a hazardous <br /> 40 CPR Part 261, wash fly defined by RECEIVING FACILITY <br /> WASTE TYPE: <br /> U,DISPOSAL Q SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> El DEBRIS U OTHER r <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> RANSPORTER NOTES: V_EHICEl=LICENSE NUMBER TRUCK NUM <br /> I3EA <br /> ADDA SSS-r`7.�;? <br /> .1 <br /> 1 <br /> CITY,STATE,ZIP <br /> PHONE' END DUMP BOTTOM DUMP TRANSFER <br /> SIGIVATURE,OF,AUTHORiZEDAGE TOR DRIVER DATE RO'L-OFF(S) FLAT-BED VAN DRUMS <br /> f�. ell <br /> ❑ ❑ ❑ ❑ <br /> TA <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 iANDFiLL) <br /> DISPOSE OTHER <br /> REMARKS U SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS. .. ' <br /> U NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENTDATE ASBESTOS <br /> } U WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> SCHEDULING.MUST BE MADE OM15RTO 3`00 RM.THE DAY PRIORTO EXPECTED ARRIVAL o ANY UNSCHEDULED LOADS ARE SUBJECT. ' <br /> TO REFUSAL UPON ARRIVAL. ONGOING:DAILY DELIVERIES MUST,BELSCHEDULED WITH:THE LANDFILL_THE.DAY.;BEFORE.. . <br /> MANIFEST <br /> GENERATOR CO?Y <br />