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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island ® Forward <br /> Samtaary 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 94565 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 /> 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 /> Chfflo>:ue 11C 28217 Q GLOVES ❑GOGGLES ❑ RESPIRATOR jU HARD HAT <br /> PHONE <br /> t5l 2 990-145 ❑TY-VEK 0 OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> i,c aru�l7iMe�� t <br /> SIGNATURE OF AUTHORIZED AGENT 1 TITLE DATE <br /> *"AAi'i .f`Ff�..,a.:r^.-� x v?,�iy o-. ! !.."*E •t �PP <br /> GENERATJl R S CERTIRPATION 1 hereby certify that the above named matenal is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code e1 regulations has been property <br /> described classified and packaged and is in proper condition for transportation a cording to applicable <br /> regulations AND If the waste is a treatment residue of a previously restricted hazardous waste <br /> subtect to the land Disposal Restnctions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 288 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ULDISPOSAL ❑SLUDGE <br /> ,U CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1r1^�1Dn'_5WW1?oad 7L JvtlT:sL <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> 13535,q <br /> CITY, STATE,ZIP <br /> Lor-ke531-c"t.A fagG3 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED 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 /> ZI SOIL <br /> REMARKS <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> r'! ASBESTOS <br /> IGNATURE OF AUTHORIZED AGENT DATE <br /> ❑ WOOD <br /> Q ASH <br /> O SPECIAL OTHER <br /> r <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 SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> MANIFEST# <br /> GENERA OR COPY i s <br />