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11 Keller Canyon ❑ Ox a oufnt'ain ❑ Newby Island -[ ,Forv+rard <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landflll <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Haff 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 /> VGNERATORWASTE ACCEPTANCE NO. <br /> LING ADDRESS f% _ <br /> IP—HONE <br /> ITY, STATE, ZIP _ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ! - U GLOVES ❑GOGGLES U RESPIRATOR U HARD HAT <br /> C1 TY-VEK l OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> 7iC _ <br /> VGENERATORTOR S CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> defined by 40 GFR Part 2&1 or tills 22 of the Calitomiatale of regulations has been property <br /> classified and packaged and ism proper condition for transportation a^cording to applicable <br /> sANditthewaste is atreatment residue of a previously restricted hazardous waste <br /> the Land Disposal Restrictions I certify and warrant that the waste has been treated mRECEIVING FACILITY <br /> e with the requirements of 40 CFR Pan M and is no longer a hazardous waste as defined by <br /> art 261 <br /> TYPE <br /> JDISPOSAL 0 SLUDGE <br /> U CONSTRUCTION U WOOD <br /> U DEBRIS U-IOTHEA <br /> L)SPECIAL WASTE <br /> GENERATING FACILITY <br /> P r <br /> All—IffIR <br /> ANSPORTER _ _ 7 NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> It ADDRESS f Jogj ' ; c t 1 7 j % �" �' <br /> ` r wa <br /> CITY, STATE,PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> „A ❑ ❑ 1:1 ❑ <br /> ,1.: f t r <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to the beat of my knowledge the foregoing ©ISPOS <br /> Is true and accurate AL METHOD (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> EMARKS U SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> U WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> HEDULING MUST BE MADE P'RIOR'I O 3 00 P M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> 10C <br /> REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL. THE DAY t3CE�FORE, <br /> MANIFEST 0 <br />