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❑ Kehler Canyon ❑ Ox Mountain ❑ Newby Isd forward <br /> Sanitary.Landfill Bary Landfill Sanitary dfill Landfill <br /> 901 BaileyAoad *,0 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)45Q-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(925)458-991 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR ,f WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS — ✓ G`7 <br /> CITY, STATE,ZIP f�1 V, _ REQUIRED PERSONAL PROTECTIVE EQUIPMEN I <br /> PHONE <br /> ❑GLOVES ❑GOGGLES O RESPIRATOR ❑HARD HAT <br /> � ;� .. <br /> ❑TY-VEK ❑OTHER <br /> CONTACT PERSON ]J SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE.'OFAUTHORIZED AGENT/TITLE DATE <br /> LL: y/ <br /> GENERATORS CERTIFICATION:I hereby codify Mat Me above named material is not a hazardous <br /> waste as defined by 40 CFR Pan 261 or lige 22 of the Calgomu code of regulations,has been property <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•previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I cartity 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 Pad 261. <br /> WASTE YPE: <br /> ISPOSAL ❑SLUDGE <br /> ONSTRUCTION ❑WOOD <br /> ❑DEBRIS UPTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTE NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY,STATE,ZIP <br /> PHONE 5M A'T END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ ❑ <br /> SIGNATURE OFAUTH ,RIZED AGENT OR DRIVER JDATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> Ll <br /> Ll <br /> L �0 6 <br /> CUBIC YARDS <br /> hereby certify that the above named material has been - <br /> accepted and to the best of my knowledge the foregoing DISPOS METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> O SOIL <br /> EMARKS <br /> O CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBE ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHOR E\DDAGENT <br /> DATE} QWOOD <br /> ❑ASH <br /> ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFI4L THE DAY BEFORE. <br /> MANIFEST/,, 66387 <br /> TRANSPORTERCOPY <br />