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`[ Keller Canyon ❑ Aountain r <br /> ElNewby Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> ,F901 Bailey Road 12310 San Mateo Road 1601 Dfxon Landing Road 9999 S.Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay, CA 94019 Milpitas,CA 95035 <br /> Phone 925 4 P Manteca,CA 95336 <br /> F- .. O ) 58 9800 Phone(fi50)726-1819 Phone(408)945-2800 Phone(209)982-4298' <br /> Fax{925 458-9891 Fax(650)72&9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR r <br /> MAfLING ADDR f 53 WASTE ACCEPTANCE NO. <br /> CITY, STATE,ZIP _.X REQUIRED PERSONAL PROTECTIVE EO <br /> UlpMENT <br /> PHONE r" _ .._, w r ,- f;^ ❑GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> O TY-VEK CI OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATDRE OF AUTHORIZED AGENT/TITLE DATE <br /> 41 l <br /> I <br /> ERATOR'S CERTIFICATION:I heroby certify that the above named material is not a hgzardous <br /> a as delined by 44 CFR Part 261 or lids 22 of the Calitomia code of regulations,has been property <br /> ribed,classified antl packaged,and is in proper condition for transportation a-cording to applicable <br /> ations;AND,If the waste Is a treatment residue of a previousy restricted heardous wasta <br /> ct to Ifie Land Disposal Reslrlctinns,f certify and warrant Thal the waste has benn boated inRECEIVING FACILITY <br /> rdance with Ile raqulrements of 44 CFR Part 266 and is no longer a hazardous waste as defined byFR Pat 261.TE TYPE: <br /> DISPOSAL U SLUDGE <br /> CONSTRUCTION ❑WOOD <br /> DEBRIS ❑OTHER <br /> SPECIAL WASTE <br /> ER>ATIN/G FACILITY <br /> TRANSPORTER f NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ' r <br /> ADDRESS <br /> i � 'P'• a a ,n� <br /> t <br /> CITY,STATE,ZIP <br /> PHONE <br /> EN- UMP BOTTOM DUMP TRANSFER <br /> = 1 nod ' " r ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROL)_"OFF S FLAT-BED VAN DRUMS <br /> �,� ❑ ❑ ❑ ❑ <br /> r r (! <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 LANORLL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> REMARKS O SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AWTHORIZED AGENT - DATE <br /> -ASH <br /> - '' �l t♦�� �y'f F <br /> ❑SPECIAL OTHER <br /> .1111101111A <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL,a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL.-ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH.THE LANDFILL THE DAY BEFORE. <br /> MANIFEST N ' � <br /> Ui�NERATOR COF11 "' <br />