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❑ Keller Canyon —[] Ox Mountain ❑ Newby Island U Forward <br /> Salnitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> • F� 9Q1'siley 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 /> 0 - <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO <br /> . tit I <br /> MAILING ADDRESS 4 00 <br /> CITY, STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> I &GLOVES D GOGGLES a RESPIRATOR\ O,-IARD HAT <br /> PHONE <br /> 0 TY VEK D OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> Aj tv <br /> GEN�TO�R.��RTIFICATION I hereby certify that the above named material is not a hazardous <br /> waste as 1i4d by 40 CFR Part 261 or title 22 of the Cahfcrnia code of regulations has been properly <br /> described classified and packaged ands in proper condition for transportation a-cord ng to applicable <br /> regulations AND If the waste is a treatment residue of a previously restricted hazardous waste <br /> subfect to the Land Disposal Restnctions I certify 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 defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> •DISPOSAL Q SLUDGE <br /> O CONSTRUCTION C]WOOD <br /> ❑DEBRIS D OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> f T <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER- TRUCK NUMBER <br /> L __ F <br /> ADDRESS <br /> CITY, STATE, ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> f _ <br /> r <br /> ! CUBIC YARDS <br /> J <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 /> ❑ SOIL <br /> REMARKS <br /> CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBR35 <br /> D NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> � Z1 WOOD <br /> D ASH <br /> O SPECIAL OThER <br /> SCHEDULING MUST BE MADE PRIORT0 3 00 PM 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 /> SALES CCP% MANIFEST# 30864 <br />