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El Keller Canyon V�� ountaln U Ne�n►by (Slat ] Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary La�fill Landfill <br /> _ 901 Bailey Road 12310 San Mateo Roar! 1601 Dixon Landing Road 9999 S.Austin Road <br /> 134tsbdfg,CA 94565 Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> y Phone(925)458-9800 Phone(650)726-1819 Phone(408) 945-2800 Phone (209)982-4258 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax (408)262-2871 Fax(209)982-1009 <br /> �r <br /> NON-HAZARDOUS WASTE MANIFEST <br /> jPN(5NE <br /> ENERATOR ; <br /> r c <br /> WASTE ACCEPTANCE NO, <br /> ;AILING ADDRESSITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> �' ❑GLOVES 0 GOGGLES 0 RESPIRATOR 0 HARD HAT <br /> U TY-VEK ❑OTHER <br /> CONTACT PERSON 'i _ <br /> ,f SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHDRIZED AGENT/TITLE DATE <br /> ,' <br /> GENERATOR'S CERTIFICATION:I hereby cortity that Ito above named material is not a hazardous <br /> -waste as defined by 40 CFR Parl 261 or title 22 o1 the California code of regulations,has been pfopedy - <br /> doscr&d,classified and pacharged,and is In proper condition for transportation a-cording to applicablo <br /> regulations;AND,If the waste H e treatment residue of a previousty restricted hazardous waste <br /> snbiec1 to[ha Land�isposat Reslfic!#one,I redily aFx1 warrant that the waste hes bean traattxl in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> ID'DISPOSAL 0 SLUDGE — <br /> O CONSTRUCTION Q WOOD <br /> O DEBRIS ❑OTHER , <br /> G SPECIAL WASTE <br /> GENERATING FACILITY , <br /> TRANSPORTER _. 4-0-4— _ NOTES: VEHfCLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> F <br /> A <br /> CITY,STATE, ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZEDAGENTOFtDRIVE~R DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> ❑ Q d <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 trueAnd accurate. r <br /> I f DISPOSE OTHER <br /> I <br /> R SOIL <br /> IFIEMARKS _.�.�_.. -- - <br /> 4 G CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER 0 NON-FRIABLE <br /> ✓a ASBESTOS <br /> SIGNATURE OF AUTHQRiZED AGENT DATE <br /> U WOOD <br /> Q ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL•ANY LINSCHED01-ep <br /> To REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULEV WITH THE LpNDFII- <br /> MpN(�E <br /> _VRANSPORTER COPY <br />