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® Keller Canyon ❑ Ox Mountain ❑ Newby Island p Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Barley-Rearl 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin !=toad <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)458-9891 Fax (650)726-9183 Fax(408)262-2871 Fax(209) 982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> =GE ERATOR ' WASTE ACCEPTANCE NO <br /> _ 3 <br /> MAILING ADDRESS442L t - <br /> r t <br /> CITY, STATE,ZIP , -- , -, 7 REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE ❑GLOVES ❑GOGGLES ❑RESPIRATOR ©HARD HAT <br /> ❑TY-VEK ❑OTHER <br /> CONTACT PERSON r . . , <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE r <br /> GENERATOR 5 CERTIFICATION I hereby certrfy that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the Cahfomia code of ragulabons has been properly <br /> described classified and packaged and is in proper condition for transportation a-cord€ng to appiraable <br /> regulabons AND If the waste is a treatment residua of a powilously rastrictod haxm^doua waste <br /> subject to the Land Disposal Resirrchons I certify and warrant that the waste has been treated In RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 266 and rs no$^or a hazardous waste as defined by <br /> 40 CFR Part26f <br /> WASTE TYPE <br /> ON ❑DISPOSAL 2 SLUDGE - - <br /> ❑CONSTRUCTION Q WOOD <br /> ❑DEBRIS Gil QTHER <br /> EV ❑SPECIAL WASTE <br /> GENERATING FACILITY -•- --• <br /> r <br /> r „ - <br /> RANSPORTER , /J V 4 ; g NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> s <br /> ADDRESS <br /> CITY, STATE, ZIP,- <br /> . a <br /> PHONE r t J / .- END DUMP BOTTOMA)UMP T ANSFER <br /> ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN RUMS <br /> F� „o ❑ ❑ ❑ ❑ <br /> i F <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 CONIPLETED BY LANDFILL) <br /> Is true and accurate w , <br /> DISPOSE OTHER <br /> O SOIL <br /> EMARKS <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE-OFAUTHORIZrzD AGENT DATE <br /> ❑WOOD <br /> .� bt�iZ) `�/ Q ASH <br /> O SPECIAL OTHER <br /> rHEDULING DUST BE MADE RIORT®3.t6 PM THE DAY PRIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED L LADS ARE SUBJE ' <br /> O REFUSAL. UPON AFIRIVAL-ONG011 `G DAILY DELIVERIES MIDST BE SCHEDULED WITH THE LANDFILL THE nAY 93EFORE <br /> MANIFEST 9 , <br />