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C] Keller Canyon ❑ Ox Mountain ❑ Newby Island ®-ror-word <br /> Sanitary-LartdfM Sanitary Landfill Sanitary Landfill Landfill <br /> 901•Badey 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)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 /> GENERATORfWASTE ACCEPTANCE NO. <br /> y r ��.t' <br /> MAILING ADDRESS44 <br /> CITY, STATE,ZIP,- - _ REQUIRED PERSONAL. PROTECTIVE EQUIPMENT <br /> -^ "- ❑GLOVES ❑GOGGLES a RESPIRATOR ❑HARD HAT <br /> PHONE <br /> QTY-VEK ❑OTHER <br /> CONTACT PERSONSPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT I TITLE DATE ` <br /> I <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 281 or title 22 of the Catifomra oode of regulations has been property <br /> described classified and packaged and Is in proper condition for transportation a-cordrng to applicable <br /> regulations AND,It the waste Is a Vestment residue of a provlousty metMeted hazardous waste <br /> subject to the Land Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance watr the requirements of 40 CFR Part 268 and is no longer a hazardous waste as detrned by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> •DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ,U OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> � f/,, .r t,`��1 f"� ` k�C ,�w` c`-' acv �� %'rte <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS 7 n;2 i C4, <br /> CITY, STATE,ZIPC-- f <br /> PHONE c-r f END DUMP BOTTOM DUMP TRANSFER <br /> r - <br /> 51GNATURE OF AUTWORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <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 /> ❑ CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑WOOD <br /> r � <br /> q ASH <br /> (7/ <br /> ❑ SPECIAL OTHER <br />'SCHEDULINGST-B AIDE PRIORTO 3:00 P M. THE DAY PRIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> To (REFUSAL UIP—O ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAV BEFORE <br /> MANIFEST" # 4 <br />