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C Keller Canyon L-1 Coffin Bette ❑Ox Mountain ❑Newby 1S18110 t'; a .° <br /> jR It iz,�•.�. <br /> Sanitary Landfill Landfill Sanitary Landfill S< aryLantAill <br /> 901 Bailey Rodd 28972 Collin rii Road 12310 San Mateo Riad 160 r'dixon Landing Road 96 ' <br /> Pittsburg. CA 94565 CorvaTs, OR 97330 Half Moon Bay, CA 94019 Milpitas, CA P5035 itj�rt <br /> Phone (925) 458-9800 Phone (541) 745-2018 Phone (650) 726-1819 Phone (408) 945-2800 I'I <br /> Fax (925) 458 9891 Fax (.541) 745-3826 Fax (650) 726-9183 Fax (408) 2632-2871 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR — WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY, STATE, ZIP REQUIRED PERSONAL PRO1EC1IV <br /> J GLOVES U GDGGLES '.J RESPlRAT0H <br /> PHONE _ <br /> iJ TY-VEK b SAFETY VEST <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: i <br /> _SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOrR'S CERTIFICATION',I hereby cerlily Ilk!theabove Warned material is not a hazardous <br /> waste as delimit by 40 CFR Part 261 eI title 22 of the California code of regulations,has been properly <br /> described,classified and packaged.2nd is in proper condition for transporlaiion according to applicable <br /> regulai AND.If the waste is a treatment residue of a previously restricted hazardous waste <br /> subjecl to the L2rrd Do-,poaal Peslrlctions,I cr;rlily and warrant that We waste has been heated in RECEIVING FACILITY <br /> accordance with the reciovements vt X111 CFR Part 268 and is no larger a hazardous waste as d¢lined by <br /> 40 GFH Part 215 1. <br /> WASTE TYPE: <br /> J DISPOSAL. IJ SLUDGE ---- ------.... _-__ . <br /> EI CONSTRUCTION ❑WOOD i <br /> LJ DEBRIS LJ OTHER - - <br /> J SPECIAL_ WASTE - I <br /> GENERATING FACILITY - -- <br /> .,. 1.tr'..t'nq+.iz,d�y <br /> MPPROPTli 77 <br /> TRANSPORTER_ NOTES: VEHICLE LICENSE NUMBER TF1 h_'IC I I <br /> ADDRESS - --`. -- - <br /> CITY, STATE, ZIP <br /> PHONE END DUMP BOTTOM DUMP <br /> L <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-SED VAi i <br /> Lj Ll L.j <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 "is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED DY <br /> DISPOSE i <br /> J SOIL <br /> REMARKS I <br /> ❑ CONSTRUCTION I <br /> FACILITY TICKET NUMBER DEBRIS _ <br /> U NON-FRIABLE <br /> SIGNATURE,OF AUTHORIZED AGENT DATE ASBESTOS - -- - <br /> J WOOD — - - <br /> r'J ASH <br /> J SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PFOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVALK'ONGOINA DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> Rev 11109 NS-024 MANIFEST # ' { <br /> GENERATOR COPY <br /> s <br />