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❑ Keller Canyon LJ O%.)ountain ❑ Newby lsla,...4 (❑'Forward <br /> Sanitary Landfill Sanitary Landfill - Sanitary Landfill 'Landfill <br /> 901 Batley Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg,CA 94565 Halt 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 /> GENERATOR <br /> -, • /, if- _ -,,,y, ,.�r`,1 WASTE ACCEPTANCE NO. <br /> r� <br /> MAILING ADDRESS <br /> CITY STATE,ZIP, _ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> t �, Ll GLOVES U GOGGLES C]RESPIRATOR Q HARD HAT <br /> PHONE # '" <br /> f�PERS�ON __ <br /> f `?L9 r! s =. 9 ❑TY-VEK ❑OTHER <br /> CONTAC ' <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> I r` ' <br /> ,r Ze <br /> GENERATOR'S CERTIFICATION.I hereby certify that the above named material Is not&'hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the Cafffomia code of regulations,has boon property <br /> described,classified and packaged,and is in proper condition for transportation a,ordirtg to applicable <br /> regulations;AND,if the waste Is a treatment residue of a previously restricted hazardous waste <br /> subiect to the Land Disposal Restrictions,I certify and warrant that the waste has bean treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no Longer a hazardous waste as dolined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> O DISPOSAL Q SLUDGE <br /> Q CONSTRUCTION U WOOD <br /> ❑DEBRIS U OTHER <br /> •SPECIAL WASTE <br /> GENERATING FACILITY <br /> L <br /> SPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ESS,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OFAUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) 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 /> REMARKS SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHQRIZED AGENT DATE <br /> U WOOD <br /> O ASH <br /> l r r r O SPECIAL OTHER <br /> mill 11111111IMM. <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,SCHEDUL.ED WITH THE LANDFILL THE DAY BEFORE." <br /> MANIFEST N <br /> GENERATOR t;t7PY <br />