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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island W-Forward <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)456-9800 "one (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 WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS ! 6 <br /> CITY, STATE,ZIP �> ?Z § ,,t� `ti t= e� _ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ©GLOVES ❑GOGGLES ❑RESPIRATOR Q HARD HAT <br /> PHONE <br /> D TY-VEK ❑OTHER <br /> CONTACT PERSON �� �� _ b i' %t �, fi s'~ SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR S CERTIFICATION I hereby consfy that the above named material is not a hazardous <br /> west.as defined by 44 GFR Part 261 or title 22 of the California code of regulatmns has been property <br /> .soribed classified and packaged and is to proper conditwn for transportation aroard�ng is applicable <br /> AND if the weals Is a treatment residua of a pravfoersly restricted hazardous weals <br /> subiact to lhs Land Disposal RestncUor,s I ce"and warrent that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Past 268 and is no!anger a hazardous waste as defined try <br /> 1,d,egulations <br /> 0CFR Pan261 <br /> ASTE TYPE <br /> ❑DISPOSAL ID SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS -Q,QTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> ANSPORTER 1,t - i t , lr a. , NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS - :'1--_,"'.1 i t t°, t t si c�-- <br /> CITY, STATE,ZIP <br /> PHONE _� } E i _� i s li END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> - n <br /> CUBIC YARDS <br /> I hereby certify that the abode 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 /> ❑ SOIL <br /> EMARKS <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER~ -`f DEBRIS <br /> f , U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> I a WOOD <br /> d ASH <br /> n$ CIAL OTHER <br /> SCHEDULING ffUST BE MADE PRIORTO 3 00 P!M.THE DAY PRIORTO EXPXCTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> ITO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL.T"E DAY BEFORE <br /> MANIFEST # 43682 <br />