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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island ❑ Forward <br />' Sanitary Landfill Sanitary Landfill Sanitary Landfill " Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,GA 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 /> Fax (925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209) 982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> IIIGENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE QZLOVES C)GOGGLES ❑RESPIRATOR I HARD HAT <br /> U TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OFAUTHORiZED AGENT/TITLE DATE <br /> `t <br />' GENERATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> waste as defined mra ed by 40 CFR Part 261 or title 22 of the Cahfocode of regulations has been properly <br /> described classsfred and packaged and is m proper condition for transportation a-cording to applicable <br /> regulations ANS,It the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions I certify and warrant that the waste has been treated 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 /> Q DISPOSAL ❑SLUDGE <br /> 0 CONSTRUCTION Q WOOD <br /> ❑DEBRIS Q OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN -DRUMS <br /> ❑ ❑ ❑ ❑ <br /> A <br /> 44 <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 /> EMAAKS 0 SOIL <br /> ❑ CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br />` <br /> I SIGNATURE OF-AUTHORIZED AGENT DATE ASBESTOS <br /> Q WOOD <br /> f F° Q ASH <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 ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> SALES COPY MANIFEST# �" i ' <br /> u <br /> 4 c;'r. <br />