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' ❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island orward <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)982-1009 <br /> INON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS 2328 <br /> CITY STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ❑GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> P E <br /> 0 TY-VEK ❑OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AG T/TITLE IDATE <br /> c� <br /> r <br /> GENERATOR S CERTIFICATION! I hereby oeN tial named material Is not a us <br /> hazardo <br /> waste as defined by 40 GFR Part 261 or file 22 of the CaaornLa code of regulations has been property <br /> descnbed classified and packaged and is h proper oorrdRian for trampor=on a-cording to applicable <br /> regulauorls ANR#ft waste 4 a treatment residue of a pmvtoltaty revirtcted hazardous waste <br /> subject to the Land DIsposat Restrictions I caroiy and warrant that Ow waste has been treated In RECEIVING FACILITY <br /> aocordance with the rogmremenfs of 40 CFR Part 26a and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WAS TYPE <br /> DISPOSAL ❑SLUDGE <br /> I ❑ $TRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 110 West Sonwnu 8t. STOCKTiON <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> I ADDRESS (�Z.Iq 7 3 ��v <br /> 351 N46A Was=ROL <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 36&67.73 ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> 9-11-oz <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> I 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 /> I <br /> REMARKS ❑SOIL <br /> ❑CONSTRUCTION <br /> I <br /> FACILITY TICKET UMBER DEBRIS p NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OV AjjU RIZED A ENT DATE <br /> ❑WOOD <br /> ❑ASH <br /> �C SPECIAL OTHER <br /> ISCHEDUL!W MUST BE MADE PRIORT03:00 P.M THE PRI RTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERSm S MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE, <br /> MANIFF4T C 77 Q A <br />