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❑ Keller Canyon ❑ O*...Iountain ❑ Newby IsIaN w ❑ Forward <br /> Sanitary Landfill Sanitary Landfill - Sanitary Landfill Landfill <br /> 901 Bosley Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg,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 /> Faxl925) 45{t8-9891 Fax(650)726-9183 Fax(408)262.2871 Fax(209) 982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> UGENERATORWASTE ACCEPTANCE NO. <br /> I G ADDRESS TATE,ZIP <br /> REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHOWE 0 GLOVES 0 GOGGLES a RESPIRATOR O HARD HAT <br /> ' <br /> ' •/, �!- 0 TY-VEK 0 OTHER <br /> CON ACS`PERSON­ <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE SPECIAL HANDLING PROCEDURES: <br /> GENERATOR• CERTIFICATION:1 hareby codify that the above named material is nota hazardous <br /> waste as defined b1'40 CFR Pad 26I or title 22 of the California code of regulation,has baun properly <br /> deacubed,classlFied and packaged,and is in Proper tonditlon for transportation a cord ng to applicable <br /> roguiawns:AND,It tht waste Is a treatment residue of a previously restricled hazardous w 'te <br /> subject to lite Land Disposal Restrictions,I certify and warrant that the waste has been freated In RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Pad 269 and is no longer a hazardous waste as delined by <br /> 40 CFR Pan 261. <br /> WASTE TYPE: <br /> Q-1)15POSAL 0 SLUDGE <br /> U CONSTRUCTION 0 WOOD <br /> 0 DEBRIS 0 OTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY ; <br /> ! it f iY',.r,:1 �..j � �I e✓� „. .0 j.. -,� � !f � <br /> TRANSPORTER _ NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS- r <br /> CITY,STATIC,ZIP - <br /> PHONE' END•DUMP BOTTOM DUMP TRANSFER <br /> S1 NA URE OF AUTHORIZED AGENT O 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 <br /> Is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> EMARKS 0 SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE, <br /> 0 WOOD <br /> DASH <br /> 0 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 /> MANIFEST# <br /> Gktl*_ZATOR COPY <br />