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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island ❑ Forward <br /> Sanitary Landfill Sa*ry Landfill Sanitary DTIII Landfill <br /> 901 Bailey Road 1231 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/(20099)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST . �!�(p � (/ <br /> GENERATOR WASTE ACCEPTANCE NO, <br /> -"AILING ADDRESS <br /> ) <br /> _ ,ITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> UCONTACTPERSON <br /> 0 GLOVES 0 GOGGLES 0 RESPIRATOR 0 HARD HAT <br /> 0 TY-VEK O OTHER <br /> SPECIAL HANDLING PRO DUKE�� �OF UTHORIZED AGEPLT/TITLE DATE / <br /> IFR.t O-'S CERTIFICATION:I hereby Canty that the dome named material is not a hazardous <br /> e as darined by a0 CFR Pan 261 or Elle 22 o1 the California code of regulations,has been properly <br /> ribed,Classified and packaged,and is in proper condition for transportation ii cording to applicable <br /> lalbns;AND,Ir the worts Is a treament resltlw of a preWOusly resVleted hazcrdoue wnotn <br /> od to the larM Disposal Restrictions.t Cedily aM wartant that the waste has Dean vested in RECEIVING FACILITY <br /> rdares,with the requirements of 40 CFR Pad 268 and is no longer a hazardous waste as defined by <br /> FR Pa,t261. <br /> TE TYPE:DISPOSAL ❑SLUDGE <br /> CONSTRUCTION O WOOD <br /> DEBRIS 0 OTHER <br /> SPECIALWASTE <br /> ERATING FACILITY <br /> NSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> .. . r F <br /> aDDvrfi <br /> :;TTY, STATE,ZIP <br /> 'HONE -" END DUMP BOTTOM DUMP TRANSFER <br /> iLrL4 f ❑ ❑ <br /> iGNATUREOFAUTHORIZEDAGENTORDRIVER DATE ROLL-OFF(S) FLAT.-BED VAN DRUMS <br /> CUBIC YARDS <br /> rFACIUTY <br /> certify that the above named material has been <br /> d and to the best of my knowledge the foregoing DISPOSAL METHOD: .(TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. DISPOSAL <br /> OTHER <br /> - O SOIL <br /> O CONSTRUCTION <br /> CKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> OF is <br /> AGENT DATE <br /> O WOOD <br /> 0 ASH <br /> SPECIAL OTHER <br /> xn4FOLI@_INGMUIRT°BEMAnFP41?3RiTn3:00RI.^.—. _. . --...''EXPECTRs,: <br />