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❑ Kellar Canyon ❑ OkQountain ❑ Newby lalal :g:.Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary landfill Landfill <br /> 901 Bailey Rord 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(4.08)945-2800 Phone(209) 982-4298 <br /> Fax(925) 458-9891 Fax(650)726-9183 Fax (408)262-2871 Fax(209)'982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY, STATE,ZIP '; REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE <br /> - Q GLOVES U GOGGLES Q RESPIRATOR 0 HARD HAT <br /> • , ` �� .. _ <br /> f%' - '� _ "- fU TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named mater at Is not a hazardous <br /> waste as defined by/40 CFR Part 261 or[ilia 22 of the Catif=4 coda of regulations,has been properly <br /> described,classifidd and packaged,and is In proper condition for lransporiaiinn a,cording to applicable <br /> regulations,AND,11 the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Wsposal Restrictions,1 certify and warrant that the waste has been treated In RECEIVING FACILITY <br /> _accordance with the raquimments 0140 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Pad 261. <br /> WASTE TYPE: <br /> q,DISPOSAL ❑SLUDGE <br /> 0 CONSTRUCTION 0 WOOD <br /> O DEBRIS 0 OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY,STATE,ZIP - <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> IGNATURE OF AUTHORIZED'AG NT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> r• <br /> 1 hereby certify that.the above named material has been <br /> accepted arid <br /> -to:the best of my knowledge the foregoing <br /> is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> `�` " DISPOSE OTHER <br /> o SOIL <br /> EMARKS <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBERr DEBRIS <br /> t U NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED•,ADATE <br /> GENT ASBESTOS <br /> y <br /> t U WOOD <br /> �T 1 <br /> 11 ASH <br /> ❑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 N <br /> .•j u <br />