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❑ Keller Canyon ❑ Ox Mountain ❑ Newby IsIp-d J,Z,Forward <br /> Sanitary Landfill V `ary Landfill . Sanitary L dfill Landfill <br /> 901`Lr Tiley Road 123KSan 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 /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> � i r• �;-' bcGLOVES D GOGGLES D RESPIRATOR HAT <br /> PHONE <br /> D TY-VEK D OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT 1 TITLE DATE <br /> 1. <br /> GENERATOR'S CERTIFICATION:1 hereby cetufy that the above named material is not a hazardous <br /> waste as defined by 46 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:AfJ%If the waste is a treatment residue of a previously restrleted hazardous waste <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> axordance with the regwrernents of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> 4t}CFR Part 261, <br /> WASTE TYPE: <br /> 13UISPOSAL ❑SLUDGE <br /> D CONSTRUCTION D WOOD <br /> Q DEBRIS D OTHER <br /> D SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER k_ 1 NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> L ASS <br /> ADDRESS � �•����� - !�I, � , <br /> r <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> Uc 5-�� - �Z�i ❑ ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> CUBIC YARDS <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 /> U SOIL <br /> EMARKS <br /> D CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER D NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT / CYA /;, <br /> t , L Q'WOOD <br /> QASH <br /> D 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 /> t MANIFEST# 38954 <br /> C.FNERATCR C;,Py <br />