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1 <br /> ,P7T'f''❑ Keller Canyon ❑ Ctv„,,,rAsauntain ❑ NewbyIslA <br /> C1-��P®cvuard <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> 9, <br /> Pittsbur CA 94565 Half Moon Bay,CA 941719 Milpitas,CA 95035 Manteca,CA 95336 <br /> *Its <br /> Phone(925)458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Pax(925)458-9891 Fax(650) 726-9183 Fax(408) 262-2871 Fax(209)982-1009 <br /> ` NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> MAILING ADD DRESS� • .c' r" - ;:,''F_ f rrr WASTE ACCEPTANCE NO. <br /> CITY,STATE,ZIP REQUIRED P <br /> -'',;; ,..,r; .:} . rr ; F} .� , -•, ERSONAL PROTECTIVE EQUIPMENT <br /> G GLOVES 0 GOGGLES ❑RESPIRATOR 0 HARD HAT <br /> PHONE -- <br /> ❑TY VEK Q OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certity that the above named material is sot a hazardous <br /> waste as dorined bl 40 CFA Part 261 or title 22 of the California code of regulations,has herrn property <br /> dascrlbed.classified and packaged,and is in proper condition for transportation a^cordirrg to applicable <br /> regulations;AND,If the waste Is a treetment residua of a Proviousty restricted hezardoua waste <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has boon treated in RECEIVING FACILITY <br /> accordance with the roquiromants of 40 CFR Part 266 and is no longer a hazardous waste as definad by <br /> 40 CFR Pad 261. <br /> WASTE TYPE: <br /> O•D(SPOSA!_ Q SLUDGE <br /> O CONSTRUCTION U WOOD <br /> Q DEBRIS Q OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> -RANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> - <br /> ADDRESS r <br /> _. . <br /> C1TY,YSTATE, IP - <br /> ff , l• J ye <br /> PHONE { - - -... <br /> END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTH RIZED AGENT OR DRIVER DATE ! ROLL-OFF(S) FEAT-BED VAN DRUMS <br /> rl ,1 I. a <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 /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT/r, - ; DATE ASBESTOS <br /> Q WOOD <br /> Q ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORT03:00 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 /> MAN IFE`ST <br /> UENERNFOR CUWY -� <br />