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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island [ Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 9Q1-Balley_,0oad 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> PitI%bdr3,CA 94565 Hall 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 <br /> r <br /> MAILING ADDRESS 4ftr_1 00 <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ❑•GLOVES O GOGGLES ID RESPIRATOR D:HARD HAT <br /> PHONE <br /> _ ❑TY-VEK 'LJ OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZE AGEIIT/TITLE DATE <br /> If <br /> GEN ERAIQU-CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Pan 261 or tale 22 of the Caldornia code o1 regulations has been properly <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 a previously restricted hazardous waste <br /> subject to the Land Disposai Resinctions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 GFR Pan 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Pan 261 <br /> Tr— <br /> WASTE <br /> iWASTE TYPE <br /> O DISPOSAL U SLUDGE <br /> ❑CONSTRUCTION G WOOD <br /> •DEBRIS a OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLEhL}CENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY, STATE, ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ U <br /> SIGNATURE OF AUTHORIZED AGENT O DRIVER JDATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> - i l <br /> CUBIC YARDS <br /> • r , <br /> I 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 /> EI SOIL <br /> FIEMARKS <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> D NON FRIABLE <br /> �' ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑ WOOD <br /> r <br /> ❑ ASH <br /> O SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 P M THE DAY PRIORTO 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 /> SA LES CCrP t MANIFEST# ) - J <br />