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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island 0 Forward <br /> Sanitant Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 90 ai ey 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 x WASTE ACCEPTANCE NO. <br /> cornoauMAILING ADDRESS <br /> y,�v i 0rKM0rt wuot y <br /> 4321 <br /> CITY, STATE,Zip REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ��`harIof `1`TC 2821 � Z GLOVES Q GOGGLES ❑RESPIRATOR no HARD HAT <br /> PHONE <br /> L� �3 "y -t it Q TY-VEK ©OTHER <br /> CONTACT PERSON <br /> Fes, I��ss' SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE, DATE <br /> r <br /> IGEgEt—WOR's CERbS1 AT1014 I hereby certify that the-above named material is not a hazardous <br /> waste as defined by 4t}CFF Tart 261 or title 22 of the California code of regulations has been properly <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 at a previously restricted hazardous waste <br /> "set to the Land Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTETYPE <br /> 12 DISPOSAL O SLUDGE <br /> /a CONSTRUCTION Q WOOD <br /> ❑DEBRIS _ ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> X00alaw ROo-d , CCF X1'7 <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS ° ' AJ <br /> 19555 W T311 load <br /> CITY,STATE,ZIP <br /> 1 M) -'efcrd'L".A95x237 <br /> PHONE END CIUMP BOTTOM DUMP TRANSFER <br /> JD ❑ ❑ <br /> SIGNATURIr OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> 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 /> Q SOIL <br /> EMARKS <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> IGNATURE OFAUTHORIZ MirGENT DATE <br /> ❑WOOD <br /> 0752 x ❑ASH <br /> y9 r .--- <br /> f ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MADE-PRIORTO 3 UO 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 /> GENERR3 QR COPY MANIFEST# q q j <br />