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❑ Keller Canyon ❑ C..,allountain ❑ Newby Islam./ ❑ 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 <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)982-4298 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR '. � <br /> WASTE ACCEPTANCE N0. I <br /> MAILING ADDRESS - -- <br /> CITY,STATE, IP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> C "" _ W)GLOVES O GOGGLES ❑RESPIRATOR "` !HARD HAT <br /> PHONE ;7C <br /> O TY-VEK 'i OTHER s�%z�, <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> SIGNATUREOFAUTHORIZEDAGENT/TITLE DATE <br /> GENERATOR'S CERTIFICAtION:I hereby cadify that the strews reined materiel is not a hazardous <br /> waste as defired by ell CFR Pan 261 or 8tla 22 of the California code of regulations,here been propedy <br /> describeQ classified and packaged,and is in proper condition for transportation a-cording b applicable <br /> ,agulatbns;AND,H the ends is a insentient readout,of a pon lously mtrided hazardous wssa <br /> subject to the Land Disposal Restrictions,I ceNy aM warrant that the waste hats been treated In RECEIVING FACILITY <br /> accordance with the requirements of M CFR Part 268 and is no longer a hazardous waste are defined W <br /> 40 CFR Pati 261. i <br /> WASTE TYPE: <br /> ❑DISPOSAL 0 SLUDGE <br /> O CONSTRUCTION U WOOD <br /> ❑DEBRIS OOTHER ,) <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> {I <br /> TRANSPORTER "` --r-- NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER �I <br /> ADDRESS( <br /> CITY,STATE,ZIP �' et - <br /> PHONE .- ��--,: a END DUMP BOTTOM DUMP TRANSFER <br /> Ll <br /> SIGNATUREOFAUTHORIZEDAGENTORORIVER DATE ROULOFF(S) FLAT-BED VAN DRUMS <br /> * / Yi <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 ---- D SOIL - <br /> -- _- ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS ' <br /> 0 NON-FRIABLE <br /> ASBESTOS, <br /> SIGNATURE OF AUTHORIZED AGEIJT AT <br /> O D <br /> � -OASH <br /> SPECIL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST k 368688 <br />