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❑ Keller Canyon ❑ C .Aountaln ❑ Newby ISlaved [] Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 991 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Roar! 9999 S.Austin Road <br /> Pittsburg,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)982-4298 <br /> �r Fax (925)458-9891 Fax(650)726-9183 Fax(408)262.2871 Fax(209)982.1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> r, WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> 4. <br /> CITY,STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ❑GLOVES Q GOGGLES U RESPIRATOR O HARD HAT <br /> PHONE <br /> QTY-VEK Q OTHER <br /> CONTACT PERSON T <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATIDIQ (hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or tithe 22 of the Caklomia coda of regulalions•has been property <br /> described,otassified and packaged,and is in proper conditloa for transportation a,cording to applicable <br /> regulations;AND.If the waste Is a treatment resldus of a previously restricted hazardous waste <br /> subject to the Land Dksposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY _ <br /> accordance with the requirements of 40 CFR Pan 260 and is no longer a hazardous waste as defined by <br /> 40 CFR Pan 261. -' <br /> WASTE TYPE: <br /> _PyDISPOSAL Q SLUDGE <br /> U CONSTRUCTION U WOOD <br /> Q DEBRIS ❑OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES: IVEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS � •~-�' <br /> CITY, STATE,ZIP <br /> PHONE r END DUMP BOTTOrrM--yy DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> r ❑ ❑ �y f ' <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 o SOIL <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> R NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> O WOOD <br /> U ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 RM.THE DAY PRIORTO 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 M <br /> GENERATOR COPY <br />