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Keller Canyon ❑ Ox Mountain ❑ Newby Island Eg Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 4 P'O1 Batley Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg, CA 94565 Halt 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) 4511-9831 Fax (650)726-91113 Fax (408) 262-2871 Fax (209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR � ,A_ WASTE ACCEPTANCE N0, <br /> MAILING ADDRESS <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE : r ° z r i L$ ❑GLOVES U GOGGLES U RESPIRATOR ❑HARD HAT <br /> ❑TY-VEK ❑OTHER <br /> CONTACT PERSON § fa t t- - 3�� SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> waste as defined by 4a CFR Part 261 or btie 22 of the California code of regulations has been properly <br /> described classified and packaged and is in proper condition for transportation a-cording to applicable <br /> regulations AND,it the waste is a tneetmmnt residue of a prevlously restricted hazardous waste <br /> subject to the Land Disposal Restrictions I certify and warrant that the waste has been treated rnRECEIVING FACILITY <br /> eccardanee with the requirements of 40 CFR Part 2x38 and is no longer a hazardous wrists as defined by <br /> 40 CFR Part261 <br /> WASTE TYPE -- — <br /> 0 DISPOSAL Q SLUDGE <br /> L❑CONSTRUCTION U WOOD <br /> Q DEBRIS U OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY y <br /> k <br /> RANSPORTER t 4 t NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS "• f f f i r f4 t1 ', <br /> CITY, STATE,ZIP i ` F , u y (_4 r— -�,!, <br /> PHONE ,�, s � , t; I # ENT]DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> 1}i Is <br /> ` F <br /> CUBIC YARDS <br /> I hereby certify that the abode named materiel has been <br /> accepted and to the best of my knowledge the fo going DISPOSAL METHOD <br /> (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate <br /> DISPOSE OTHER <br /> ❑ SOIL <br /> REMARKS ` \ ,� 1 <br /> s U CONSTRUCTION <br /> FACILITY TICLKETNUMBER <br /> DEBRIS <br /> ❑ NON-FRIABLE <br /> t ASBESTOS <br /> SIGNATURE ORIZE A£ENT DATE <br /> .. � Q WOOD <br /> 1 r Q ASH <br /> �fl Q SPECIAL OTHER <br /> ISCHEDULING MUST BE MADE PRIORTO►3 00 P M.THE DAV PRIORTO EXPECTED ARRIVAL P ANY UNSCHEDULED LADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES DUST BE SCHEDULED WITH THE LANDFILL. THE DAY BEFORE <br /> MANIFEST <br />