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Q.-Keller Canyon F1 Ox F' jntain ❑ Newby Islander onward <br /> Sanitary Landfill Sanry Landfill Sanitary Landfill Landfill <br /> 901 Balley Load 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(406)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 WASTE ACCEPTANCE NO. <br /> MAILING ApDR S — c�-- <br /> %ice <br /> STATE,ZIP, REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE, GLOVES ❑GOGGLES ❑RESPIRATOR iWARD HAT <br /> ❑TY VEK Q OTHER <br /> CONTA T PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIG A� 1� RE OF AUTHORIZED AG NT—/TITLE DATE <br /> * W <br /> GENERATOR'S m0enFicxnoM:1 hereby certity that the above reamed materiel is not a hatardmis <br /> waste as defined by 40"CFR,Part 261 or tills 22 of the Callfornla code of regulations,hes beeri property. - <br /> daseribed,classified and Packaged.and Is N proper condition for transportation axonfin9g to applkstda <br /> rraeggu�la�tiona;AND,if the waste is a breafinerd residue of a previously restricted hazardous was% <br /> sugect to the Land Dlsposal:Restrlctlorrs;I certify and warrent that the waste hes teen treated In RECEIVING FACILITY <br /> acoordarm with the requiremerds of 40 CFR Pan 268 and is no longer a hazardoua waste as defined by <br /> " <br /> 40 CFR Part 261. - - - <br /> WASTE TYPE: <br /> ❑DISPOSAL ❑SLUDGE <br /> Li CONSTRUCTION ❑WOOD <br /> Q DEBRIS ❑OTHER <br /> QftPEC;IAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS G <br /> CITY,STATE,ZIP <br /> PHONE" END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OFAUTHORW AGENTOR D IVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to the best of-my knowledge the foregoi <br /> Is true and accurate. ng 1 PosAL METHOD (TO SE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> EMARKS ❑SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> L]WOOD <br /> Q ASH <br /> O SPECIAL OTHER <br /> -Namm mum <br /> SCHEDULING MUST BE MADE.PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> MANIFEST# 53761 . <br /> I.AAi FILL COPY <br />