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(Kellet Canyon ❑ ax Mountain ❑ Newby Island 0`--r-orward <br /> Sanitary Laqfill Sanitary Landfill Sanitary Landfill Landfill ' <br /> 901 Baileq'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) 45B-9800 y _ 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 /> t <br /> GENERATOR / " WASTE ACCEPTANCE NO.- t <br /> MAILING ADDRESS <br /> CITY, STATE, ZIP , REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> U GLOVES Ll GOGGLES U RESPIRATOR U HARD HAT <br /> PHONE ' <br /> LI TY-VEK LI OTHER <br /> CONTACT PERSON // /f 1,; <br /> F / SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous ' <br /> waste as defined by 40 CFR Part 261 or title 22 of the Caldomra 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,It the waste is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with She requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 ! <br /> WASTE TYPE <br /> U DISPOSAL U SLUDGE <br /> U CONSTRUCTION U WOOD <br /> U DEBRISTIaIF� <br /> U SPECIAL WASTE s" <br /> GENERATING FACILITY <br /> s <br /> TRANSPORTER A .1 , NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS _,r " /11/i <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVERT DATE ROLL-OFF(S) FLAT-BED v VAN DRUMS s <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 COMPLIED BY LANDFILL) <br /> Is true and accurate <br /> DISPOSE OTHER <br /> U SOIL <br /> EMARKS ❑CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> UASH <br /> f U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE IPRIORTO 3 OOP M TETE DAY PRIOR TO EXPECTED ARRIVAL.•ANY UNSCHEDULED LOADS ARE SUB JE <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL..THE � R <br /> MANIFEST # <br />