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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island 'Ea 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 /> co NON-HAZARDOUS WASTE MANIF=EST <br /> GENERATOR "Co CoWASTE ACCEPTANCE NO <br /> 0 tC C . A/ <br /> AILING DDRESS _ �� <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 57- L gJLI C- GLOVES 0 GOGGLES 0 RESPIRATOR 0 HARD HAT <br /> PHONE <br /> ❑TY VEK ❑OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> %A/916 Hr VI Al 14Vi7 - El: j2d91 ,N <br /> _ <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATEtJy�L <br /> GENERATOR S Ct=RTIFICATION I hereby cerbty that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code 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 waste Is a treatment residue of a previousty restricted hazardous waste <br /> subject to the Land Disposal Restrictions I certity and warrant that the wasto has been treated In RECEIVING FACILITYe yCJ <br /> accordance with the requirements of 40 CFR Part 26B and to no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> IWASTETYPE <br /> i <br /> 0 DISPOSAL 0 SLUDGE <br /> 0 CONSTRUCTION 0 WOOD <br /> 0 DEBRIS 0 OTHER <br /> ❑SPECIAL WASTE So 1 l-- ]+ 0M._ /4Zr <br /> GENERATING FACILITY <br /> TRANSPORTER (-, L)A,-Z (A c4dj& NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS f1 f1e, <br /> CITY,STATE,ZIP f ' �� <br /> PHONE - l END DUMP BOTTOM DUMP TRAN FER <br /> SIGNATURE OF AUTHORI AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN RUMS <br /> * l <br /> CUBIC YARDS <br /> I hereby certify that above named material has been <br /> i <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 /> 0 SOIL <br /> REMARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑WOOD <br /> 0 ASH <br /> 0 SPECIAL OTHER* 11111111111111111110 .. -. <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 /> MANIFEST#1 50475 <br /> GENERATOR DOPY <br />