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❑-Keller Canyon ❑ Ox Mountain ❑ Newby,Island Forward ' <br /> _ Sanitary Landfill I Sanitary Landfill ' Sanitary Landfill Landfill <br /> 901 Bailey%Road 14310 San Mateo Road 1601 bixon 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 (400262-2871 Fax(209) 982-100 <br /> NON-HAZARDOUS WASTE MANIFEST : <br /> GENERATOR ' fi ` f WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS, <br /> CITY, STATE, ZIP SW JY REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> -�� =-C=`- U GLOVES U GOGGLES U RESPIRATOR U HARD HAT <br /> PHONE <br /> U TY VEK U OTHER <br /> CONTACT PERSON, _ SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> s <br /> GENERATOR S CERTIFICATION 1 hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 of btle 22 of the California code of regulations has been property <br /> described classified and packaged and is in proper condition for transportation a-cordsng to appitcable <br /> regulations AND,N the waste is a treatment residua of a prevtousty restricted hazardous waste <br /> subject to the Land Disposal Restrictions I oarbfy and warrant that the waste hag been treated in RECEIVING FACILITY <br /> accordance with Vie requiremonts of 40 CFR Pari 2118 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ❑DISPOSAL U SLUDGE <br /> ❑CONSTRUCTION O WOOD <br /> •DEBRIS V QTHER <br /> a SPECIAL WASTE <br /> GENERATING FACILITY yy � y [ <br /> F <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY,STATE,ZIP <br /> PHONE �'s i d ! °� et ; ( END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS F <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 DIsPo3AL METHOD (TO BE COMPLETED B'Y I.ANDFILL)- <br /> j is true and accurate <br /> DISPOSE OTHER <br /> ❑ SOIL <br /> REMARKS <br /> D CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OFAUfiHORIZEDAGENT ( DATE <br /> Q WOOD <br /> ! i U ASH <br /> 71C E ! f <br /> t-7/0 O SPECIAL OTHER <br /> SCHEDULING MUST BE IiADE P R10RTO i P M THE DAY PRIOR TO EXPECTED ARRIVAL a ANY UNSCHEDULEID LOADS ARE SUIt$.!E <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL. TFIE fAAY BEFOR <br /> MANIFEST * 43481 <br />