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❑ Keller Canyon ❑ C, ,fountain ❑ Newby Islas" ❑ Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road i <br /> Pittsburg,CA 94565 Halt 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 /> GENERATOR - - WASTE ACCEPTANCE NO. I <br /> MAILING ADDR - <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> GLOVES ❑GOGGLES ❑RESPIRATOR IHARD HAT <br /> PHONE <br /> ` O TY-VEK OTHER ZA <br /> V <br /> CONTACT PERSON ' - <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT TITLE DATE <br /> GENERA `S CERTIFICATIQN:I hereby roniy that 0e above namef Material is not a havardeus <br /> waste as Boned by 40 CFR Pan 261 or title 22 of the Califomia cafe of regulations,has been property <br /> ibed, I <br /> &,b devoted and packaged,and is in proper condition for transportation a-corfir to applicable <br /> regulations:ANM If Ne waste Ie a Maintains tasidue of a pre rlousy restricted hasardous waste <br /> subject to Ne land Disposal Restrictions,l certify and warrant that the waste has been heated in RECEIVING FACILITY <br /> aaomarce with the reoutremenls of 40 CFR Pan 266 and is no longer a hazardous waste as defined by <br /> 40 GFR Part 261. <br /> WASTE TYPE: <br /> ❑DISPOSAL O SLUDGE <br /> ❑CONSTRUCTION O WOOD 1 <br /> ❑DEBRIS O OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> ` TRANSPORTE NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS 7 <br /> 1 <br /> CITY,STATE,ZIP <br /> PHONE { - END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OFAUTH RIZEDAGENTORDRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> 1 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 /> REMARKS ❑SOIL <br /> ❑CONSTRUCTION I <br /> FACILITYTICKET NUMBER <br /> DEBRIS <br /> ONON-FRIABLE <br /> ASBESTOS <br /> SIGNATOR FAUTHORIZEDAGENT !'— DATE <br /> L]SPECIAL OTHER <br /> { <br /> I <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT j <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> % <br /> MANIFEST COPY # 368689 <br /> p 3 6 v 6 8 9 <br />