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❑ Keller Canyon ❑ ox Mountain ❑ Newby Island ❑ Forward <br /> Sanitary,LandfillItary Landfill Sanitary&dfIII Landfill <br /> 901 Bailey Road 1 San Mateo Road 1601 Dixon COMIng Road 9999 S.Austin Road <br /> * 111111ilebO, 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) 982-4298 <br /> Fax(925) 458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENE OR WASTE ACCEPTANCE NO. <br /> MA161 ADDRESS <br /> 390(D . i <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE <br /> 0 GLOVES 0 GOGGLES 0 RESPIRATOR 0 HARD HAT <br /> ❑TY VEK 0 OTHER <br /> CorqTACr F59RSON <br /> SPECIAL HANDLING PROCEDURES: <br /> GNATUR F AUTHORIZED AGENT/TITLE <br /> DATE <br /> &=g!L <br /> GENERATOR'S CERTIFICAT om I that the above named material is not a hazardous <br /> waste as duNined 40 CFR Part 281 or 22 of the California code of reguiations,has been property <br /> clas®Ifled arW. and is in proper condition for transportation a-cording to applicable <br /> re 11 bns;AND.H weds is a"troatmeat residue of a previously restricted hazardous waste <br /> sudJsd b Bee Land I car*and warrant that the waste has been treated in RECEIVING FACILITY <br /> 40 CFR P the requirements of 40 CFR Part 288 and is no longer a hazardous waste as defined by <br /> WASTE TYPE: <br /> 0 DISPOSAL ❑SLUDGE <br /> 0 CONSTRUCTION 0 WOOD <br /> 0 DEBRIS O OTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRA PORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> =U CA-1 ADD SS <br /> CIMSTATg,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGN ATUR AUTH2EI D AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN D UMS <br /> ❑ ❑ ❑ ., <br /> CUBIC YARDS <br /> hereby certify that the above named ImAtetial has beefs-, <br /> accepted and to the best of my knowledge the aforegoing <br /> Is true and accurate. DISPCdSAL•METHOD: (TO BE COAAPLETD BY LANDFILL) <br /> y <br /> DISPOSE OTHER <br /> EMARKS 0 SOIL _ <br /> _ O CONSTRUCTION <br /> AGILITY TIC NUM - DEBRIS <br /> ,Q NON-FRIABLE <br /> IGNATUR OFA IZE -"ASBESTOS <br /> T •,�.. :�` DATE . <br /> 0 WOOD <br /> U ASH ; <br /> * 77,- <br /> F-2 SPECIAL OTHER <br /> - T` <br /> DUI NQ <br /> MUST BE MADE IPRIORTO 3aIt1 RI�I.TH S Am <br /> ;MY M, a b A tIR �;:e KidYaJi SCH pUirEC?t <br /> TO REFUSAL UPON ARRIVAL. ONQOING �1AILY iQ IVEPiIIE S ilii - SG"HEDULEb W&H THE L:AN1b01 THS d�i"11//Y�� BEI�ibIle' <br /> '* gr=NEEi�t' t*CPPV, .. MANIFEST# 9#. <br />