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r ❑ Kehler Canyon ❑ 6.40ountain ❑ Newby Isla <br /> rd <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill ❑ LandForwfill <br /> sQ1 Bailey Road I_and#Ili , <br /> y ad 1 <br /> • 23i0 San Mateo Road 1 fi01 Dixon Landing Road 9999 S.Austin Roac! <br /> P,ittsb6rg,CA 94565 Half Moon Say,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 /> Fax (925)458-9891 Fax(650) 726-9183 Fax(408)262-2871 Fax (209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR ' WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS _ <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EOUIPMENT <br /> PHONE ❑GLOVES O GOGGLES U RESPIRATOR Q HARD HAT <br /> Q 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 material is not a hazardous <br /> waste as defined by 40 CFR Pan 261 or 111la 22 of the California code of regulations,has been proporty <br /> described,classified and packaged,and is in proper condition for transportation n-cording to applicable <br /> regulations;AND,If the welts is a treatment residua of a previously restricted hazardous west* <br /> subject to the Land Msposal Restrictions,I certify and warrant that the waste has been lreatad in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Pan 268 and Is no longer a hazardous waste as defined by <br /> 40 CFA Part 261. <br /> WAST .TYPE: <br /> abISPOSAL U SLUDGE <br /> U CONSTRUCTION Q WOOD <br /> 0 DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> L. :,ts; •""�`=, , 1 _ f'I' ''ria <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> .i •Sr 1 <br /> ADDRESS <br /> CITY,STATE,ZIP, <br /> PHO .E END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FIAT-BED VAN DRUMS <br /> i <br /> CUBIC YARDS <br /> I hereby certify that the above named mate�rial,hs been <br /> accepted and to the best of my knowledg 4 eregoing <br /> is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED 8Y LANDFILL) <br /> V' <br /> i DISPOSE OTHER <br /> tt S <br /> 1 G7 SOIL <br /> EMARKS <br /> O CONSTRUCTION <br /> FACILITYTICKET NUMBER DEBRIS <br /> 4 NON-FRIABLE <br /> r ASBESTOS <br /> SIGNATURE OF AUTHORIZED A. NT !* DATE <br /> r ❑WOOD <br /> 1' <br /> U ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILYDELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE- <br /> MANIFEST ift i, -"•s � <br /> TRANSPORTER CODY J U.� ,+ .. <br />