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Keller Canyon ❑ Ox Mountain ❑ Newby Island E2LF-orward <br /> ant <br /> SanitaYy Landfill Sanitary Landfill Sanitary Landfill �T Landfill <br /> 90'1 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road MS Austin Road <br /> itt0urg,CA 94565 Halt Moon Bay,CA 94019 Milpitas,CA 95035 Manteca, CA 95336 <br /> Phond 99?5)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 r i WASTE ACCEPTANCE NO. <br /> ~r <br /> MAILING ADDRESS f <br /> J `,.f W 2 ! 1 /EZ, �' �1 dam-+E <br /> CITY, STATE, ZIP, REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> f I� i-i7 Jr T r i �- O GLOVES U GOGGLES O RESPIRATOR iD HARD HAT <br /> PHONE <br /> Q TY-VEK U OTHER <br /> CONTACT PERSON f' l r SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT I TITLE DATE <br /> GENERATOR S CERTIFICATION i hereby certify that the above named malanat is not a hazardous <br /> waste as defined by 40 CFR Part 261 or ntle 22 of the California code of regulations has been properly <br /> deacnbed classified and packaged and is rn proper condition for transportation a-=ding to applicable <br /> regulations AND,1t the waste in a treatment residua of s 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 the 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 DEBRIS THER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS ' <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> n 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 /> U SOIL <br /> EMARKS <br /> U CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER ID NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DTE O WOOD <br /> f lL/ <br /> U ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3 00 RM THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL OMGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> MANIFEST # 43675 <br />