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f <br /> ❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island 1�sForward <br /> Sanitary Landfill Sanitary Landfall Sanitary Landfill `r Landfill <br /> 901 Salley Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pttsburg,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 /> GENERATOR// e- WASTE ACCEPTANCE NO <br /> MAILING ADDRESS F / Y _ j �g <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE <br /> ❑GLOVES U GOGGLES a RESPIRATOR ❑HARD HAT <br /> PERSON <br /> TY VEK L1 OTHER <br /> CONTACT � _ <br /> r!£ ` r - +r �W . i ; SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> 1 r 3f <br /> GENERATORS CERTIFICATION I hereby certify that the above named material m not a hazardous <br /> waste as defined by 40 CFR Part 261 or hila 22 of the Cahiomra code of regulations has been properly <br /> described classified and packaged and is in proper condition for transportation a-cording to applicable <br /> regulations AND H this waste Is a treatment residue of a previously restricted hazardous watts <br /> subject to the Land Disposal Restrrcbons I certrty and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 GFR Part 260 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> O DISPOSAL ❑SLUDGE - - <br /> L7 CONSTRUCTION ❑WOOD <br /> U DEBRIS THER <br /> C3 SPECIAL WASTE <br /> GENERATING FACILITY <br /> IFRANSPORTER NOTES VEHICLE LICENSEE NUMBER TRUCK NUMBER <br /> ✓ I =' r ' F rF i c j�". t'.. r ,r+_ f --1�f�S f C ! ft�< <br /> ADDRESS J f <br /> CITY, STATE,ZIP <br /> PHC}NE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(§ FLAT-BED VAN DRUMS <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 DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate <br /> DISPOSE OTHER <br /> EMARKS ❑ SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> S GNATI.)RE OF AUTHORIZED AGENT DATE <br /> Q WOOD <br /> ❑ASH <br /> -QSPECIAL OTHER <br /> F4EDULING MUST BE MADE PRIORTO 3 00 P M.THE DAY PRIOR TO EXPECTED ARRIVAL*ANY UNSCHEDULED!_GADS ARE SUBJECT <br /> O REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST SE SCHEDULED WITH THE LANDFILL THE DAV BEFORE <br /> MANIFEST 0 Aqr,7A <br />