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�tg�, � nab,«f�a<t"'°^ ...�t'°`E "4FS'I�`r � <br /> i- ""-U, <br /> a "x�m <br /> n ❑,Kehler Canyon ❑ QxYMouniain _ ' � k!F�o <br /> x S,anitary' L'andfiii Sanlf&r Landfifi 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 Say, 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 /> ' GENERATOR �-' -4 14:r <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> t - � � <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHO E v 1 i Q GLOVES 0 GOGGLES 0 RESPIRATOR Q HARD HAT <br /> ❑TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> Q SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT I TITLE DATE <br /> GENERATOR 5 CERTIFICATION I hereby certify that the above named matenal is net a hazardous <br /> waste as defined by 46 CFR Part 261 or title 22 of the California code of regulations has been properly <br /> se <br /> denbed ciassffied and packaged and rs in Proper condition for transportation a-cording to applicable <br /> regulations AND,!t the waste Is a treatment residue of a previousty restricted hazardous waste <br /> sut)jw to acoe Land <br /> d Disposal Restrictions I candy and warrant that the waste has been treated in <br /> accrdance RECEIVING FACILITY <br /> CPR Pen 2th etturrements of 4o CFR Part 266 and is no longer a hazardous waste as defined by <br /> WASTE TYPE <br /> Q DISPOSAL 0 SLUDGE <br /> 0 CONSTRUCTION 0 WOOD <br /> 0 DEBRIS �I OTHER <br /> 0 SPECIAL WASTE ♦\ <br /> GENERATING FACILITY <br /> TRANSPORTER7-1---P), NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS -- '� <br /> CITY, STATE, ZIP` -� 7 z <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN D UMS <br /> 1 _/ ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD <br /> Is true and accurate (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> EMAR1fS ❑ SOIL <br /> 0 CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER <br /> L 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATU E OFA GENT I DATE <br /> 0 WOO <br /> 1 <br /> G � H <br /> 0 SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 P M HE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARF_SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> f, <br /> MANIFFRT a Ci n' <br />