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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill 1--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,C995336 <br />' Phone(925)458-9800 Phone (650) 726-1819 Phone(408)945-2800 Phone(209) 982-4298 <br /> Fax(925)458-9891 <br /> Fax(650) 726-9183 Fax (408) 262-2871 Fax(209)982-1009 <br />` NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> I f1 I L 1' 1 <br /> MAILING ADDRESS <br /> DA I) t�✓ 1 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Q I n L�G� 5r7 GLOVES U GOGGLES U RESPIRATOR U HARD HAT <br /> I PHONE <br /> UTY-VEK 0OTHER <br /> CONTACT PERSON i p SPECIAL HANDLING PROCEDURES <br />' SIGNATURE OF AUTHORIZED AGENT 1 TITLE DATE <br /> 1 � �` <br />' GENERATOR S CERTIFICATION I hereby cadify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or boo 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 applaable <br /> regulapons AND,If the watts is a tresttttent residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restnchons I car*and warrant the,the waste has been treated in RECEIVING FACILITY <br /> I accordance with the regwrements of 40 CFR Part 2138 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE WO <br /> U DISPOSAL U SLUDGE <br /> I U CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> pECIAL WASTE <br /> GENERATING FACILITY <br /> I <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> 1vv EZ>i <br /> ADDRESS <br /> CITY, STATE,ZIP <br /> ` JIE1 <br /> PFy,ONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> Wr f <br /> *,^4 q9 f A-:r'� !' ! � •r 1r"7'�+ y � f..c � n"r LJ <br /> _ r <br /> CUBIC YARDS <br /> 1 hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foreguing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate <br /> DISPOSE OTHER <br /> I Q SOIL <br /> REMARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIASI_E <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> IU WOOD <br /> U ASH <br /> U 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 /> GENERATOR COPY MANIFEST# <br /> 285759 <br />