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❑ Keller Canyon E-1 " lli5rMountain ❑ Newby Island Worward <br /> Sanitary L.andflil Sanitary Landfill 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 Bay, CA 94019 Milpitas, CA 95035 - Manteca,CA 95336 <br /> Phone (925)458-9800 <br /> Fax (9 5)458-9891 Phone 0 <br /> Fax(650) 726-9183 Phone (408) 800 08 <br /> 18310 Fax(408)262 287Fax(209)982-Phone (209) 51009 ' <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR I {r WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY, STATE,ZIP _ -- REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> C_ t -f r- � ;r ' '`T ._ ❑GLOVES U GOGGLES 0 RESPIRATOR ❑HARD HAT <br /> PHONE ' <br /> ❑TY-VEK ❑ OTHER <br /> CONTACT PERSON s F r 4 SPECIAL HANDLING PROCEDURES <br /> f r 'f r 1 <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 Casitomra 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,If the waste Is a treatment residue of a prwiously 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 GFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 GFA Part 261 <br /> WASTE TYPE <br /> 0 DISPOSAL ❑SLUDGE <br /> 0 CONSTRUCTION Q WOOD <br /> ❑DEBRIS 'Q,,QTHER , <br /> C]SPECIAL WASTE <br /> MillIGENERATING FACILITY <br /> A r �'�f f � � 9 f L.�,f4(_ (r let <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS e f 1��—T 77 <br /> CITY, STATE, ZIP <br /> PHONE - T END DUMPT-�—BOTTOM DUMPA _- TRANSFER <br /> T SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF S — FLAT-BED-- VAN,--- DRUMS - <br /> f <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 /> o SOIL <br /> REMARKS <br /> ❑CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER 0 NON-FSIABLE <br /> / ASBESTOS <br /> SIGNATURE OF AUTHORIZEDIAGENT DATE 0 WOOD <br /> � f O ASH <br /> 0 SPECIAL OTHER <br /> SCHEDULING MU BE MADE PRIORT'O 3.00 P M.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED!AADS ARE SUBJE <br /> TO REFUSAL UP N ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THER <br /> MANIFEST # 4 0 <br />