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❑ Keller Canyon ❑ Ox Pte, antain ❑ Newby Islanc,. ❑ Forward <br /> R Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 90 i,oailey Road 12.310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsbutg,CA 94565 Half Moan Bay, CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> -Phone(925) 458-9800 Phone(650)726-1819 Phone (408) 945-2800 Phone (209)982-42x8 <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 /> ❑GLOVES ❑GOGGLES O RESPIRATOR El HARD HAT <br /> r O TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> �— SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:1 hereby certify that the above named materfar is not a hazardous <br /> waste as defined by 40 GFR Part 261 or title 22 of the Calilornia code o1 regulations,has been property <br /> described,cfassiliod and packaged,and is in proper condition for lransportatron a-cording to appfiaable <br /> regulations:AND,11 the waata in a trantment reslduo of a proviou"restricted hazardous waslo <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has boon treated in RECEIVING FACILITY _ <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> •DISPOSAL Q SLUDGE <br /> Q CONSTRUCTION C)WOOD <br /> ❑DEBRIS ❑OTHER <br /> O 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 /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <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 /> ❑ SOIL <br /> EMARKS <br /> d CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> 0 WOOD <br /> y 0 ASH <br /> �.....� 0 SPECIAL OTHER <br /> SCHEDULING MUST BE MADE.PRIOPTO 3.00 Ps M.7 HE DAY PRIORTO EXPECTED ARRIVAL G ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDIFIlU THE DAY [BEFORE. <br /> MANIFEST# <br /> TI ANSPORTEi1 C'f',PY <br />