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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward <br /> Sanitary Landfill u Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Batlay Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsbdrg,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)982-4 9>� <br /> Fax (925) 458-9891 Fax(650)726-9183 Fax (408) 262-2871 Fax(209)982-1 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR f - I J' <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS 1 - r f , , <br /> - <br /> CITY, STATE, ZIP, -� REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE <br /> U GLOVES 0 GOGGLES J RESPIRATOR 0 HARD HAT <br /> U TY VEK 0 OTHER <br /> CONTACT PERSON !-� , , 1- • s SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE — <br /> fa f <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material Is not it hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations has been property <br /> descnbod classified and packaged and is in proper condition for transportation a carding to applicable <br /> regulations AND,if the waste is s trsahrrent rssldus of a praviousy restriotad hazardous waste <br /> sul:)wt to the Land Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> U DISPOSAL U SLUDGE <br /> U CONSTRUCTION ❑WOOD <br /> ❑DEBRIS tIP-HER <br /> U SPECIAL WASTE f <br /> GENERATING FACILITY <br /> TRANSPORTE , S!_ - _ NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> 'l� - <br /> ADDRESS f r �'� r ~� <br /> CITY, STATE,ZIP r> !- <br /> PHONE ' -�? _ t17 7 END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMSZM SEE= , <br /> CUBIC YARDS i <br /> I hereby certify that the above named material has been <br /> Im <br /> accepted and to the best of my knowledge the foregoing <br /> Is true and accurate DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL} <br /> DISPOSE OTHER <br /> ©SOIL , <br /> EMARKS <br /> 0 CONSTRUCTION <br /> FACILITY TICKE7 NUMBER DEBRIS <br /> r ASBESTOS <br /> ❑ NON-FRIABLE <br /> SIGNATU E F AUT ORIZED AGENT DATE <br /> {! ❑WOOD <br /> fr U ASH , <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORT0 3 Oil P M THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MIDST BE SCHEDULED WITH THE LANDFILL. THE DAY BEFORE <br /> MANIFEST# A q A Q 9 <br />