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Keller Canyon ❑ 0*.oloulntain ❑ Newby lslak..,o El, Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 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)982-4295 <br /> �r 'Fax(925)458-9891 Fax,(650)726-9183 Fax(408)262-2871 Fax(209)982.1009 <br /> NOIJ-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> I.�•_ . WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE } r r: y`e rrf Rc ff A"�: U GLOVES CI GOGGLES EIRESPIRATOR ©HARD HAT <br /> I]TY-VEK U OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE,OF AUTHORIZED AGENT l TITLE DATE <br /> i <br /> GENERAToR'S CERTIFICATCphT[C froreby codify lhal the above named material is n01 ah azardous <br /> waste as dafinetl by 40 CFq Pan 261 or silie 22 0!Iho CaliloMia code of regulalWns,has bean Properly <br /> described.classified and packaged,and Is in proper cation For transportation a-cording to applicable <br /> regulations:AND,11 the waste Is a treatment ntdtlw aT pravlouary restricted haiardvus waste <br /> sut]�aCt 10 the land Disposal Restrictions,J conily and warrant That Iho wade has been UBaled In RECEIVING FACILITY <br /> acmrdanca with the requirements of a4 CFR Pad 2.and is no longer a hazardous wade as dofinad by <br /> AO CFq Part 2ti1. <br /> WASTE TYPE: <br /> 9,0I8POSAL Oi SLUDGE <br /> Q CONSTRUCTION a WOOD <br /> ❑DEBRIS O OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES. VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> DDRESS t !' t r fes ; !i<..!.•.t r <br /> t i <br /> Po <br /> o <br /> CITY,.STATE,ZIP Lf. :Frr/•` ' <br /> PHONE! ' ' END DUMP BOTTOM DUMP TRANSFER <br /> �- ars _ rs� T� ❑ ❑ <br /> SIGNATURE OF AUTHORIZED'AGENT OR DRIVER DATE ROLL-OFF S) FLAT-BED VAN DRUMS <br /> y` ❑ ❑ ❑ ❑ <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 /> O <br /> REMARKS SOIL <br /> *CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> L)WOOD <br /> o ASH <br /> l ' <br /> 'U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3,00 P.M.THE DAY`PMORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE.SCHEDULED WITH THE LANDFILL THE DAY,BEFORE. <br /> MANIFEST aw 7 <br /> GLNL-'RATOR COPi <br />