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❑ Keller Canyon ❑ 0*,.1ountain ❑ Newby isla,,.d -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 /> Pittsaure,CA 94565 Halt Moon Bay, CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925) 458-980p, 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 EQUIPMENT <br /> T ` / �� ' PY, ❑GLOVES O GOGGLES ©RESPIRATOR 0 HARD HAT <br /> PHONE <br /> M Q TY-VEK D OTHER <br /> CONTACT PERSON ' <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:i hereby certify that the allose named material Is not a hazardous <br /> waste as defined by 40 CFA Pad 261 or title 22 of the CaMornia code of regulations,Inas been properly <br /> described,classified and packaged,and is In proper condition for transpodalion a'cording to applicable <br /> regulations;AND.If the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFA Pad 258 and is no longer a hazardous waste as defined by <br /> 40 CFR Pert 261, <br /> WASTE TYPE: <br /> .LLDISPOSAL C]SLUDGE <br /> O CONSTRUCTION a WOOD <br /> U DEBRIS U OTHER <br /> •SPECIAL WASTE <br /> GENERATING FACILITY <br /> (r.:¢!`a r ; ;f`'< ,ray"; .h.. .i�•�yif1 l� + <br /> r� <br /> TRANSPORTER: - - NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS ~ <br /> CITY, STATE,ZIP <br /> PHONE j ` END DUMP BOTTO��Myy DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFSS) FLAT-BED VAN DRUM <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 D SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> f O.ASH <br /> F .VSPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 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# <br /> (�t=Pf a•'r;A i()?i C:nig v <br />