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Keller Canyon ❑ Ox Mountain ❑ Newby island `\,O'Forward , <br /> •Sanitar Landfill Sanitary Landfill Sanitary Landfill �f _ -L-arldfill <br /> 900 Bailey oa& ' 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 Phone (650) 726-1819 Phone(408) 945-2800 Phone(209)982-4296 <br /> Fax(925) 458-9891 Fax (650) 726-9183 Fax(408) 262-2871 Fax(209) 982-1 om <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR " d 4 ; w - , r _ <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY, STATE, ZIP, ; REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE - _ UGLOVES ❑GOGGLES D RESPIRATOR 0 HARD HAT <br /> ❑TY VEK U OTHER <br /> CONTACT PERSON t i ..x • r ° ' SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR S CER-nFICATION t hereby Carafy that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulatrans has been properly <br /> described ctassrlied and packaged and is to proper condition for transportation a--cording to applicable <br /> regulations AND It the waste Is a treatment residue of s praviousty restricted hazardous waste 4 <br /> sub{act to the Land Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> with the requirements of 40 GFR Pari 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ❑DISPOSAL U SLUDGE <br /> U CONSTRUCTION 0 WOOD <br /> ❑DEBRIS q ZHER <br /> U SPECIAL WASTE "^ <br /> GENERATING FACILITY <br /> IV <br /> TRANSPORTER .�,d , - NOTES VEHICLE LICENSE:NUMBER TRUCK NUMBER <br /> ✓C 11 tg <br /> ADDRESS 5 z s 4- c <br /> CITY, STATE,ZIP ~ rl = <br />-- PHONE - - T� END DUMP BOTTOM DUMP T TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS r FLAT-BED T VAN DRUMS <br /> 0 <br /> y <br /> CUBIC YARDS <br /> 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 7BYLANDFILL) <br /> DISPOSE OTHER <br /> EMARKS U SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ' 1 <br /> SIGNATURE OF AUTHASBESTOS ORIZED g4 NT' DATE / <br /> I U WOOD <br /> } f U ASH <br /> ✓� 1 USPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3.00 P.M TI DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT' <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY B�vEFORE <br /> MANIFEST# AR A R <br />