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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island /5,F.orward <br /> • Shnitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <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- <br /> Fax (925)458-9891 Fax(650) 726-9189 Fax(408) 262-2871 Fax(209) 982-1 <br /> ar I <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR/ ,/ - <br /> t' - WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY, STATE,ZIP -- _ - REQUIRED PERSONAL.-PROTECTIVE EQUIPMENT <br /> PHONE U GLOVES U GOGGLES U RESPIRATOR G HARD HAT <br /> Q TY-VEK ©OTHER <br /> CONTACT PERSON t t r r t-i •;" < , ` ` <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GEhIERATOR S CER riFlGAfiQfy I hereby certrfy that the stove named matenal is rwt a hazardous <br /> waste as defined by 44 GFR Part 26f or bile 22 of the Callfomta code of regulations,has been properly <br /> desonbed classrfied anti packaged and to to proper canddron Eor trensportatron a cordmg to appheable <br /> reguWtlons AFti3 if the waato Is a treatment residue of a previously raatr}eted haxarsious waste <br /> subieot to the Land Disposal Restnctwns t certify end warrant that the wade hes been rented in RECEIVING FACILITY <br /> accordance with the rugwrements of 40 CFR Pari 2G8 and rs no longer a hazardous waste sa defined by <br /> 40 CFR Part 2S1 <br /> WASTE TYPE <br /> ❑ DISPOSAL IJSLUDGE <br /> O CONSTRUCTION ❑%lPOD <br /> Q DEBRIS " -a4TIAEEi <br /> ❑SPECIAL WASTE w r' <br /> GENERATING FACILITY _ <br /> TRANSPORTERNOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> -V w'` <br /> ADDRESS -7,V,'/ <br /> 2214 <br /> CITY, STATE,ZIP <br /> PHONE _ 4-�,- END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN UMS <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been _ <br /> accepted and to the best of Wiry knowledge theforegoing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate <br /> DISPOSE OTHER ' <br /> EMARK <br /> ❑ SOIL <br /> ( A U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ` <br /> SIGNATURE OF AUTHORIZED AGENT E DATE ASBESTOS <br /> Fes, f U WOOD <br /> f/ <br /> DASH <br /> C ❑ SPECIAL OTHER <br /> mmwumI <br /> SCHEDULING MUST BE MA16E PRIORTO 3.00 R Mk THE DAY PRIORTO EXPECTED ARRIVAL.•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL, UPON'ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY <br /> a ® aAY�pB+�EFORE <br /> 6AAArrCCC"Y u 4i <br />