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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$ Austin Road <br /> r)ttsburg,CA 94565 Haff 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 /> GEN oR WASTE ACCEPTANCE N0. <br /> 1 D <br />' MAILING ADDRESS Ole <br /> CITY TATE ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> D GLOVES U GOGGLES U RESPIRATOR U HARD HAT <br />' PHONE <br /> U TY VEK U OTHER <br /> CONTAC PERS914 <br /> _ SPECIAL HANDLING PROCEDURES <br />' SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br />' GENERATOR'S CERTIFICATION i hereby car*Drat the above named matwW Is not a hazardous <br /> waste as defined by 40 CFR Part 261 or lite 22 of Ce Cahfomia Code of regulations,has been property <br /> described close fW and padcaged,and Is In propercondition for trarnporUdion armordkV to applicable <br /> regulahons AND,ff the waste Is a traabnor t reaWua of a pre*Kmly cosh ted hazardous waste <br />' subjw to the Land mvosai Restrictions,i car*and warrant that the waste has been treated in RECEIVING FACILITY <br /> acoardanca w4h the raguirements of 40 CFR Pall 266 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> SPOSAL U SLUDGE <br />' O CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> lid /la �,✓�ii Ste .- s� s <br /> TRAN PORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> 4 <br /> ADDRESS C <br /> CITY,STATE,ZIP <br />' r <br /> PHONE EN MP BOTTOM DUMP TRANSFER <br /> SIGNATURE—PF AUTHORIZED AGENT OR DRIVER DATE ROLLS FLAT-BED VAN DRUMS <br /> * Q� <br /> CUBIC YARDS <br /> 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 /> EMARKS <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br />' D NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT ASBESTOS <br /> DATE <br /> ❑WOOD <br /> U ASH <br /> * U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED 1-Qa c ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THLw — BEFORE. <br /> n cl n R It MANIFEST# <br />