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Illrlllll i I� <br /> ❑ Keller Canyon ❑ Gji,,,,A®Iantain ❑ Newby lsl4 <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 94566 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 /> i . 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 /> 1,i-) <br /> O GLOVES ❑GOGGLES ❑RESPIRATOR O HARD HAT <br /> PHONE <br /> r D TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OFAUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify Thal the agave named material Is not a hazardous <br /> .. waste as defined by 40 CI=F Part 261 or title 22 of the Caillomia code of raguiallans,has been property , <br /> described,classified and packaged,and is in proper condlllon for transportation a-cording to applicable <br /> reguratkmu:AND,11 the waste is s treatment resldUs of a previously restricted harerdous 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 d dp CFR Pert 266 and is rte longer a hazardous waste as defined by i <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> U DISPOSAL O SLUDGE <br /> C] <br /> CONSTRUCTION' ❑WOOD <br /> O DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 01 <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> r ' ice. <br /> Y, <br /> ADDRESS <br /> CITY,STATE,ZIP <br /> PHONE END UMP BOTTOM DUMP TRANSFER <br /> SIGNATURE�OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <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 /> I <br /> U sarL <br /> REMARKS O CONSTRUCTION <br /> FACILITY TICKET NUMBER ,' DEBRIS <br /> ❑NON-FRIABLE I <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> ❑ASH <br /> f- ,.. <br /> i SPECIALOTHER <br /> SCHEDULING MUST BE MADE PRIOR TO:3:00 iP.M.THE DAY PRIOR TO EXPECTED ARRIVAL-ANY UNSCHEDULIED LOADS ARE SUBJECT" <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVE€IES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> MANIFEST# <br /> GENERA T CSR COPY <br />