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❑ Keller Canyon ❑ C*,..,tountain ❑ Newby lala,r,� ❑ forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Read 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsbumg, CA 94565 Halt 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 /> �r <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR _ <br /> ' rs. t.: WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE a GLOVES Q GOGGLES U RESPIRATOR Q HARD HAT <br /> CONTACT PERSON U TY-VEK O OTHER <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERT)FICATION;I hereby carlify that the above named material Is not a hazardous <br /> waste as dOned by 40 CFA Part 251 or titla 22 of 1he California code of regulations,has 17een properly <br /> described,clasalfiad and packaged,and is in proper condition for transpartation a-cording to applicable <br /> regulations;AND,It the,waste Is a treatment residue of■prevlouefy restricted hnzardous waste <br /> subject to the Land Dlsposal Resiricfions,I certify and warrant that the wasto has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFA Part 266 ard <br /> find Is no longer a hazardous waste as defined by <br /> 40 CFA Pan 251. <br /> WASTE TYPE: <br /> t7 DISPOSAL Q SLUDGE <br /> U CONSTRUCTION Q WOOD <br /> DEBRIS U OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> -RANSPORTER NOTES: VEHICLE LICENSE NUMBER I TRUCK NUMBER <br /> i <br /> i/ 1 -... <br /> ADDRESS <br /> CITY, STATE,ZIP ' <br /> zi 4-2 <br /> PHONE' END DUMP BOTTOM DUMP TRANSFER <br /> SIG'NA URE OF AUTHORIZ `AGENT OR DRIVERJDAfTERO pF S 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 /> EMARKS Q SOIL <br /> U CONSTRUCTION <br /> I-ACILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> O WOOD <br /> GASH <br /> UYSPECIAL 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# "y 9 <br /> GENERATOR COPY s... `? <br />