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❑ Keller Canyon U Ot ®un#ain - -❑ Newby Islami Forward <br /> Sanitary, Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 90f Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg, CA 94565 Haff Moon Bay,CA 94019 Milpitas, CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9900 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(925) 468-9891 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 ADDRESS <br /> CITY,STATE,ZIP REQUIRED PERSONAL_ PROTECTIVE EQUIPMENT <br /> PHONE <br /> A' ?"'k. r�' T-� f'-~'£` Q GLOVES 0 GOGGLES Q RESPIRATOR Q HARD HAT <br /> • <br /> !f a ,''S T / Q TY VEK 0 DTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATUR-E OF AUTHORIZED AGENT l TITLE DATE <br /> �• r <br /> GENERATOR's CERTIFICATION:I hereby certify that the above named material ie not a,hazarddus <br /> waste as doanad by 40 CFA Part 261 or title 22 of the California code of regulations,has been properly <br /> described,classified and packaged,and is in proper oondilion for transportation a,cording to applicable <br /> regulations;AND,11 the waste Is a trestment reatdue of a prevloualy restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has boon treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and Is nn longer a hazardous waste as defined by <br /> 40 CFH Part 261 <br /> WASTE TYPE: <br /> Q DISPOSAL Q SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> R DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> r <br /> E <br /> _J 9 <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY,STATE,ZIP <br /> I �._S f 7�.tGr- "FSI "�f-J <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> �! ❑ ❑ ❑ ❑ <br /> F 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 LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> U SOIL <br /> REMARKS <br /> -' O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> :! ASBESTOS <br /> SIGNATURE OF.AUTHORlZEB AGENT ` DATE <br /> - a wooD <br /> - r <br /> ASH <br /> �❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M-THE DAY PRIOR TO 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# <br /> (GENERATOR C OP'i <br />