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i l <br /> I I <br /> 4 <br /> y ❑ U,���ountain <br /> [j Keller Canyon ❑ Newby lila�j 2 -Forwbrd <br /> Sanitary Landfill Sanitary landfill <br /> Sanitary Landfill Landfill <br /> ' ...901 Bailey Road 12310 San Mateo Raid 1601 Dixon Landing flood <br /> g 9999 S.Austin Road <br /> PjtisbuC9, CA 94565 Half Moon Bay, CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> s 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 -•• y ; <br /> - - �- WASTE ACCEPTANCE NO. <br /> AILING ADDRESS <br /> CITY;STATE,ZIP_~ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> O GLOVES ❑GOGGLES Q RESPIRATOR Q HARD HAT <br /> HONE ',' � <br /> O TY-VEK 0 OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT 1 TITLE DATE <br /> 4f <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material Is not a hazardous <br /> wa8f6 as defined by 40 CFR Pad 261 or Lille 22 of the Cafitornla code of regulations,has boon propefiy <br /> described,classitiud and packaged,and Es in proper condition for transportation a•eording to applicable <br /> regulations;AND,if the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restricllons,I certify and warrant that the waste has been treated in <br /> aoeordance with the requirements of 40 CFR Pad 268 and is no longer a hazardous waste as defined by RECEIVING FACILITY <br /> 45 GFR Pad 261. <br /> WASTE TYPE: <br /> •❑'DISPOSAL Q SLUDGE <br /> Q CONSTRUCTION ❑WOOD <br /> ❑:DEBRES ❑OTHER <br /> CD SPECIAL WASTE <br /> GENERATING FACILITY <br /> I <br /> TRANSPORTER NOTES: VEHICLE LICE=NSE NUMBER TRUCK NUMBER <br /> AD KESS ` <br /> CITY, <br /> fSTAT E,ZIPt <br /> PHONE / END'DUMP BOTTOM DUMP TRANSFER i <br /> SIGNATURE OF AUTHO91ZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> A <br /> CUBIC YARDS <br /> I <br /> 1 hereby sertify that the above named material has been <br /> accepted and to the best of my knowledge Ahekforegoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. r`,! <br /> DISPOSE OTHER <br /> r U SOIL <br /> REMARKS = <br /> j Q CONSTRUCTION <br /> FACILITY TICKET NUMBER s j DEBRIS . <br /> �. ., ❑NON-FRIABLE <br /> i ' ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT ': DATE <br /> Cl WOOD <br /> i ❑ASH <br /> r <br /> Q SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M:THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> " TO.REFUSAL UPON ARRIVALONGOING DAILYDELIVERIES.MUST BE.SCHEDULED WITH:T <br /> HE.LANDFILL THE DAY. BEFORE.- <br /> liAAfY1PE37# � ..:- r .• <br /> , s <br /> GENERATOR - . :" <br />