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❑ Keifer Canyon ❑ 0,,,.Jounta1n ❑ Newby lafa,,.,o ❑ Forward <br /> ' $ahitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> • 901 Bailey Road 12310 San Mateo Rdad 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)982-4298 <br /> 'Fax(925) 458-9891 Fax(650)726-9183 Fax (408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> JGENERATOR _ <br /> WASTE ACCEPTANCE N0. <br /> MAILING ADDRESS <br /> CITY, STATE,ZIP' .., REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> i' ❑GLOVES Q GOGGLES Q RESPIRATOR Q HARD HAT <br /> P <br /> C <br /> HONE <br /> L]TY-VEK O OTHER <br /> ONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR`S CERTIFICATION:I hereby certify that the above named material Is not a hazardous <br /> waste as defined by 40 CFR Pad 261 or aIle 22 of the Cawornia Cade of ragutations,has been properly <br /> descliz,cjassiiied and packaged, m <br /> and is in proper condition far transportation a-cordirrg to applicable <br /> regulalions:AND,If the waste Is a and <br /> resides of a previously restricted hazardous waste <br /> subject ro the Land Disposal Restrictions,I certify and warrant that the waste has been Irealed In RECEIVING FACILITY <br /> as:cordance with the requirements of 40 CFR Pad 26a and is no longer a hazardous waste as dotined by <br /> 40CFR Part 261. <br /> WASTE TYPE: <br /> QT51SPOSAL U SLUDGE <br /> O CONSTRUCTION Q WOOD <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER _ NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY,'STATE,ZIP <br /> PHONE END bump BOTTOM DUMP TRANSFER <br /> r`Ylf ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE <br /> ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> r ❑ a ❑ ❑ <br /> yrs FJ <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 /> REMARKS Q SOIL <br /> CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OI=AUTHO IZED AGENT DATE <br /> a WOOD <br /> DASH <br /> 0 SPECIAL OTHER <br /> pill <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 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 A 7 n ��-: ' <br /> C,I-:.1IL-RN-l'OR COPY . <br />