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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island �I] 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,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 /> . Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1409 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> ve+ <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ❑GLOVES U GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> PHO E <br /> ❑TY VEK 0 OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATU FAUTHORIZED AGE T/TITLE JDATE. <br /> GENERAToA s CERTIFICATION I hereby iha named material is not a hazardous <br /> waBle as defined by 40 CFR Part 261 or title 22 of ani stomia code of regulations,has been Properly <br /> described classdied and packaged and is M proper condition for transportation a-oording to applicable <br /> regolatione AND,If the waste Is a Geaunerd residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictkms I carbiy 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 /> WAST PE <br /> ISPOSAL U SLUDGE <br /> 07ONSTRUCTION u WOOD <br /> Q DEBRIS ❑QTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> 110 Weak$aroma Sit 9TOC N <br /> I TRANSPORTER <br /> n NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> I ADDRESS 77 <br /> 351 N ti <br /> CITY, STATE,ZIP <br /> PHONE t, EnQQUMP BOTTOM DUMP TRANSFER <br /> 209 17 ❑ ❑ <br /> SIGNATU OF AUTHOfFED AGENT OR DRIVER '4 TE ROL (s)_ FLAT-BED VAN DRUMS <br /> t} ❑ ❑ ❑ ❑ <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 /> Q SOIL <br /> EMARKS <br /> ❑CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER-- ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OFA IZED AGEK DATE <br /> Q WOOD <br /> ILLL <br /> O SH <br /> U ❑SPECIAL OTHER <br /> SCHEDULI ST BE MADE PR RTO 3:00 P.M.THE DAY PRIG TO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAPON ARRIVAL NGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> ■■„�„, ,.,,,r, MANIFEST# 1 A 7 7 4 4 <br />