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�{�� i�Et�a� n� _ c - <br /> za-_ � wl���+ea is��-.�«1' S 1 <br /> Keller Can on ❑t ,m n .t: <br /> ❑ Ox ountai , _ <br /> s y � ,� ❑ Newby�lsland' <br /> �SanitaryLandfill Sanitary"Landfill ' Sahita Mrd' <br /> ly andfI Landfill <br /> 9�'%Balley Road 12310 San Mateo Road 1601 Dixon Liiniing Road 9999'S Austin Road <br /> Pitt burg,CA 94565 Half Moon Bay,-CA 94019 Milpitas,CA 95035 Manteca, CA 95336 j <br /> Phone Q5)458-9800 Phone (650)726-1819 Phone(408)945-2800 Phone(209)982 <br /> Fax (925)458-9891 Fax(650)726-9183 Fax (408)262-2871 Fax(209) 982-10� <br /> NON-HAZARDOUS WASTE MANIFEST <br /> R <br /> GENERATOWASTE ACCEPTANCE ISO: ' <br /> r r � , <br /> MAILING ADDRESS <br /> _ I } <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE <br /> ❑GLOVES ❑GOGGLES Q RESPIRATOR Q HARD HAT <br /> O TY-VEK Q OTHER <br /> CONTACT PERSON _ _ <br /> x� SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE 5� <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material a not a hazardous <br /> waste as defined by 40 CFR Part 261 or htta 22 of the Caldomra code of reputations has been property <br /> described classified and packaged and is in proper condition for transportation a^cording to applicable <br /> regulations AND,If the waata is a treatment residue of a previously restrtoted hazardous waste <br /> sublect to the Land Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requnrsmertls of 40 CFR Prot 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> 0 DISPOSAL Q SLUDGE <br /> Q CONSTRUCTION ❑WOOD <br /> Q DEBRISHER <br /> 4 SPECIAL WASTE <br /> GENERATING FACILITY <br /> / 4 <br /> o i <br /> TRANSPORTER ,., NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS 6 /SrO/ <br /> CITY, STATE,ZIP <br /> T PHONE END DUMP BOTTOM DUMP TRANSFER _ <br /> T <br /> SIGNATUR <br /> E <br /> OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED F VAN DRUMS <br /> � ( ❑ ❑ ❑ ❑ i <br /> - r E <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 <br /> Is true and accurate DISPOSAL METHOD (TO BE COMPLETED BY4 ANDFILL) <br /> t . <br /> DISPOSE OTHER <br /> REMARKS O SOIL ' <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT TE ASBESTOS <br /> Q wooD <br /> 1 Q ASH <br /> Q SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3.00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SU13JECT� <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE�AY,!BEFORE- <br /> MIFEST <br /> ANalk � ' , <br />