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Keller (;anyon Lj u puntaIn L I Iaewu Islet U, r-arv�ara <br /> ,., Sanitary Landfill <br /> Sa <br /> 'Wary I_�Indfi(I Sanitary La fill Landfill <br /> Y1'v 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 /> fes. <br /> NON-HAZARDOUS WASTE MANIFEST , <br /> GENERATOR t WASTE ACCEPTANCE NO. <br /> MAILING ADDRESSV <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> O GLOVES U GOGGLES U RESPIRATOR ❑HARD HAT <br /> PHONE <br /> U TY-VEK U OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OFAUTHORiZED-AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> waste as defined by 4o CFR Part 261 or the 22 of the CalftmIa code of regulations,has been property <br /> described,classified and packaged,and is in proper oondillon for transportation a-cording to applloabfe <br /> regulallons:AND.Ii the wade Is a treatment residue of■previously restricted hazardous waste <br /> suNecl to the Land Disposal Restrictions,I certify and warrant that the waste ties been treated in RECEIVING FACILITY <br /> axordance wish the requirements of 40 CFR Part 260 and Is no longer a hazardous waste as dehned by <br /> 40 CFR Part 261, <br /> WASTE TYPE: <br /> ]DISPOSAL U SLUDGE <br /> L]CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER, NOTES: VEHICLE LICENSENUMBER TRUCK NUMBER <br /> l: <br /> ADDRESS { t' <br /> CIT,STATE,,ZIP ! <br /> � � r� - " �•l"r ..,rte .: <br /> PHONE ; END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OFAUTHORIZED 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 /> REMARKS <br /> U CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> ` U ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3;00 RKTHE DAY PI1IORTO EXPECTED ARRIVAL.*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO PEFUSAL, UPON ARRIVAL. ONGOING DAILY DELIVElkiES MUST RE SCHEDIJILED WITH THE LANDFILL THE DAY BEFORE. <br /> MANIFEST N 38199 <br /> GENERATOR COPY ;s== <br />