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U 'Keller Lanyon U Ox Mountain ❑ Newby Island -Cl Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey T3oad- ., 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 /> { <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> . C �o:�mrirt,�rsti,�:;t,:.I?�as:a;;c:�r:..�t <br /> MAILING ADDRESS <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> SAO&Mn(nLCA,9S483. <br /> PHONE U GLOVES ❑GOGGLES O RESPIRATOR O HARD HAT <br /> 4.925o o 9424) <br /> ❑TY VEK O OTHER <br /> CONTACT PERSON <br /> Sx�npamdk-,h. ; SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE O(:-AUTHORIZED AGENT/TITLE <br /> C '� { Jl ' <br /> GENERATORS CERTIFICATION:1 hereby certify that the above named material is not a hazardous <br /> wash as defined by 40 CFR Part 261 or title 22 of the California cods 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 watts is a treatment residue of a previously restricted hazardous waste <br /> sub*d to the Land Disposal Restrictions,I codify 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 claimed by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> O DISPOSAL O SLUDGE <br /> $.=;. 000NSTRUCTION O WOOD <br /> O DEBRIS .O OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> 3,j <br /> 'TRANSPORTER <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY,STATE,ZIP <br /> ONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ <br /> If <br /> CUBIC YARDS <br /> hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing <br /> is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> EMARKS O SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br />' SIGNATURE OF AUTHORIZED AGENTDATE ASBESTOS <br /> O WOOD <br /> O ASH I <br /> O SPECIAL OTHER <br /> EAULING MUST BE MADE'P_RIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> �*EFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> �' TRANSPORTER COPY MANIFEST# . <br />