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❑ Keller Canyon ❑ 0%,lountain ❑ Newby Islami ❑ Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 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 (92M 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 _ <br /> - WASTE ACCEPTANCE NO. <br /> MAILING ADDpESS <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> (�PHONE ©GLOVES Q GOGGLES Q RESPIRATOR a HARD HAT <br /> �.' �- <br /> '`n _ ,'., /�- i7 sj• O TY VEK Q OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT!TITLE DATE <br /> • GEN7RATOR'S CERTIFICATION:I hereby certify thal the above named material is not a hazardous <br /> waste as defined by 40 CFR Pad 26 f or litle 22 of the California code of regulations,has been properly <br /> described,classified and pankaged,and is in proper condition for transportation a-oording In applicable <br /> regulations;AND,If,the weds is a treatment residua of a previously restricted hazardous waste <br /> subject to the Land Disposal Roslrictions,I certify and warrant that the waste has been treated!n RECEIVING FACILITY <br /> accordance with the requirements Of 40 CFR Part 268 and is no longer a hazardous waste as defined bT <br /> 40 CFR Part 26 1. <br /> WASTE TYPE: <br /> U-DISPOSAL Q SLUDGE <br /> a CONSTRUCTION a WOOD <br /> 0 DEBRIS a OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> �- <br /> TRANSPORTER NOTES; VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS 1�� (J {� �z <br /> rrY, <br /> CITY, STATE,ZIP <br /> PHONE:" END DUMP BOTTOM DUMP TRANSFER <br /> Zi <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> y <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. y <br /> t.n DISPOSE OTHER <br /> x <br /> EMARKS Y a solL <br /> a , Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> `� ,', .� QNON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> +i l Q ASH <br /> Q SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRI ORTO 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.LANDFILLTHE DAY'.BEFORE. <br /> MANIFEST* 7 f'L;� <br /> GENERATOR COP't ` '- `^r <br />