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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island [ , onward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill 6 ILandfill <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)982-1009 <br />' NON-HAZARDOUS WASTE MANIFEST <br /> uxy0 wacnolm <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS 2328 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHO E 0 GLOVES 0 GOGGLES 0 RESPIRATOR U HARD HAT <br /> ❑TY-VEK ❑OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> shim ERRIY­ <br />' SIGNATU RE OF AUTH5RIZED AGEN3F/TITLE DATE <br />' GENERATOR S CERTIFICATION I hereby certify that Wabove named material Is net a hazardous <br /> waste as deRned by 4o CFR Part 251 or title 22 of the California code of regulations has boon property <br /> desrsibed dasaifled and packaged,and to In proper condition for transportation a^cording to applicable <br /> regulatio s ANO,N the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions I tartly and warrant that the waste has been treated in RECEIVING FACILITY <br /> aocordance with the requirements of 40 CFR Part 258 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WAW TYPE <br /> ISPOSAL ❑SLUDGE <br /> ❑OPNSTRUCTION ❑WOOD <br /> Q D03RIS ❑OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> 110 Wei#8 St. b"POGK"PON <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> S1 <br /> CITY, STATE,ZIP <br /> PHONE E UMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZ D AGENT OR DRIVER DATE RO S FLAT-BED VAN DRUMS <br /> �j- g 1 f OZ. ❑ ❑ ❑ ❑ <br /> ECUBIC 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 /> EMARKS ❑SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OFAUTHORIZED AGENTDATE <br /> � ❑wooD <br /> ❑ASH <br /> O SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3.00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY <br /> Yr+BEFORE. <br /> ^ <br /> AAA AIICCQT F ! ID C! <br />