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❑ Keller Canyon ❑ Ox Mountain -Nzwby Island Forward ' <br /> ,Sanitary 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 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)982-42'� <br /> Fax (925) 458-9891 Fax{650) 726-9183 Fax (408) 262-2871 Fax(209) 982-1� <br /> NON-HAZARDOUS WASTE MANIFEST + <br /> GENERATOR <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY, STATE, ZIP-- - },r ^A r, , , �} REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE <br /> Q GLOVES U GOGGLES Q RESPIRATOR O HARD HA <br /> O TY VEK U OTHER <br /> - CONTACT PERSON _ <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT!TITLE DATE <br /> 1 <br /> GENERATOR S CERTIFICATION 1 hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or tills 22 of the California code of reguiatsons has been properly <br /> described classified and packaged and is in proper condn;on for transportation a-cording to applicable <br /> regulations AND If the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restnctims I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance wsth the requirements of 40 GFR Part 268 and is tic longer a hazardous waste as delined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> U DISPOSAL U SLUDGE. <br /> U CONSTRUCTION - " Q WOOD " <br /> ❑DEBRIS ,OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITYsm <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS `' --s , t` f ` r ' /f� _ 4 <br /> CITY, STATE, ZIP,- <br /> PHONE <br /> IP,PHONE r`' - t 'f -F END DUMP BOTTOM DUMP TRANSFER ' <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> if <br /> ✓ v + L r <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been _ <br /> accepted and to the best of my knowledge the foregoing DI <br /> is true and accurate SPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> ❑ <br /> EMARKS SOIL <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER ,` DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZ9"0ENT � DATE <br /> ti� _ , I y _ ❑ WOOF <br /> s r <br /> ASH`/ <br /> !!!1} D SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3 00 P M THE DAY PRIOR TO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJE <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> . ____ ^ r- r% rN '4 <br />