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F <br /> ❑ Keller Canyon l_! Ootl taln !J Newby Isiah 0- 1-Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing <br /> Road 9999 S.Austin Road <br /> ^�• Pittsburg,CA 94565 Half Moon Bay, CA 94019 Milpitas,CA 95035Manteca,CA 95336 <br /> Phone(92.5)458-9800 Phone(650)726-1819 Phone(406)945-2800 Phone(209)982-4298 <br /> 'Fax(925)458-9891Fax (650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NONHAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> r`f ;�: < ,,,.� ;;,��•r - Y. WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS_ 7 1 <br /> P - <br /> C11Y - <br /> .� . ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT I <br /> - -PH _, O GLOVES ❑ L ONE � >- GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> r <br /> O TY-VEK ❑OTHER <br /> i CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE �JATE <br /> Xj <br /> "'GENERATOR'S CERTIFICATION:I horaby oemlty that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 251 or[ilia 22 of the Cafrlornis code ol regulations,has been property <br /> described,classified and packaged,and Is in proper Gond+Sion for transportaSon a-cording to applicable <br /> regulations;AND.If the waste Is a treatment residue of a prevtousfy restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I comity and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 258 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: I <br /> -IJ'61SPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION C1 WOOD <br /> ❑;DEBRIS ID OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> _r. � � `".f i`!.• .±,, � rte' <br /> TRANSPORTER = NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS J .7 <br /> CITY,,STATE,ZIP <br /> !'J <br /> PHONE' END DUMP $OTTOM DUMP TRANSFER <br /> SIGNATURE OF AUT ORIZ,ED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> r,- <br /> r l �t"z .•- i <br /> 7k '' <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 /> 0 SOIL <br /> EMA'RKS <br /> ❑CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> D WOOD <br /> U ASH <br /> 7�C 3 0 SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:40 P.M.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 R 7 <br /> GENERATOR 1710P1 <br />