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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island Adforward <br /> I Sanitary Landfill Sanitary Landfill Sanitary Landfill v LCIndfill <br /> 901 Batley 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 /> I 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 /> GENERATOR A WASTE ACCEPTANCE NO <br /> MAI IN ADD SS 02e <br /> CI TATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> d 2 a GLOVES O GOGGLES ❑RESPIRATOR U HARD HAT <br /> PHONE r <br /> 3-7 D TY VEK t7 OTHER <br /> COn%Qj PER N SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED A /TITLE DATE <br /> V <br /> I GENERAmirs CERrincAm Ni i trereby candy that the above named malens!Is not a hazardous <br /> waste as defined by 40 CFR Pat 251 or ripe 22 of the Capias code of regubdions,has been poopedy <br /> descrbed daswW and pad aged and Is in PmoPe►emrdtion for tMnSPotaibn Wxordaq to aPPIcat1s <br /> regUiations AND,it the waste is a usobneut realdua of a prsomwv reatteted hazardow treats <br /> aublecl to the Land otspoeel Resutcriom I oarmy and warrant mat the waste has been treated In RECEIVING FACILITY <br /> e000rdarrce wdh the requirements of 40 CFR Part 25tt and Is no brger a hazardous waste as defined by <br /> 4a CFR Part 261 <br /> WA E TYPE <br /> ISPOSAL ❑SLUDGE <br />' ❑CONSTRUCTION U WOOD <br /> O DEBRIS O OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br />' ADDRESS <br /> CITY,STAT ,,ZIP <br />' s2 <br /> PHONE ENRIDUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROt.L-0 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 foregoing DISPOSAL METHOD' (TO BE COMPLETED BY LANDFILL) <br />' Is true and accurate. <br /> DISPOSE OTHER <br />' U SOIL <br /> REMARKS <br /> CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br />' ONON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OFAUTH IZED Lr2 ENT DATE o WOOD <br /> H <br /> 4 ECTAL OTHER <br /> INS <br />' SCHEDULIN 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 BEFORE- <br /> -- _ MANIFEST 9 R 4 R 1 <br />