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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island ❑ Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill 'i 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 /> NON-HAZARDOUS WASTE MANIFEST <br /> EERAT R " om 'r, WASTE ACCEPTANCE NO <br /> LIN ADDRESS 7 <br /> Y, STAtE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> __j` T p _k L f-11.1,4, ' '� >` GLOVES ❑GOGGLES CI RESPIRATOR ❑HARD HAT <br /> PHONE ' <br /> ❑TY VEK ❑OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE t,4�: L 7�4,-"B A-,j14 ' <br /> * �' `�• �1fL'*JL+e.✓ �.'k�17 ;1f�Lri — !° .o-� ' <br /> GENERALOR S CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> waste as tletlned by 40 CFR Part 261 or title 22 of the CalllDMia code of 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 Disposal Restrictions 1 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 t <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ❑DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER <br /> Q SPECIAL WASTE yam) <br /> GENERATING FACILITY ,V <br /> TRANSPORTE I ; __ - _FI NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> � 3 <br /> ADDRESS <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNAT R O AJTH RIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ,_ ❑ ❑ ❑ ❑ <br /> * f. <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to the nest 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 <br /> DEBRIS <br /> Gt NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑ WOOD <br /> ❑ASH <br /> ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 P M THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> MANIFEST# 50 4 41 <br /> GF.W-f MTOR COPY ' <br />