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orward <br /> i Keller Canyon ❑ Ox Mountain ❑ Newby Island � <br /> Sanitat'y Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pit burg,CA 94565 Halt Moon Bay, CA 94019 Milpitas, CA 95035 Manteca,CA 95336 <br /> Phone(925) 458-9600 Phone(650) 726-1819 Phone(408) 945-2800 Phoni '(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 /> fti r ; <br /> MAILING AD ESS <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE r GLOVES 0 GOGGLES 0 RESPIRATOR 0 HARD HAT <br /> ❑TY-VEK 0 OTHER <br /> CONTACT PERSON <br /> r SPECIAL HANDLING PROCEDURES <br /> IIIIIIIIIISIGNATURE OFAUTHORIZED AG T/TITLE DA <br /> GENERATOR 8 CERTIFICATION I hereby oerbfy that the above named matenaf Is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the CalAomEa code of raguiatrons has been property <br /> descnbed classified and packaged and is in proper condition for transportabon a-carding 10 applicable <br />' regulations AND,It the waste to a treatment residua of a previously restricted hazardous waste <br /> subject to the land Disposal Restrictions I certify and warrant that the waste has b"n treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 GFR Pan <br /> 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> 0 DISPOSAL 0 SLUDGE <br /> 0 CONSTRUCTION 0 WOOD <br /> ❑DEBRIS HER <br /> *SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER- NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP T NSF^JE-R <br /> SIGNATURE OF AUT RIZ -D 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 />' REMARKS 0 SOIL <br /> 0 CONSTRUCTION <br />' FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> IGNATURE OF AUTHORIZED AG D E <br /> 0 WOOD <br /> 0 ASH ,^ <br /> rQ SPECIAL OTHER � Y <br /> �f+-a^Gig Y� E i .iF-IlGl�u4 ,tyi'-�^n }n" ^M ! �„W�^n}•+c+`a A ud.,. ano-A�i pirwYv S WMt{. �^rl .any y .-f ar$v�""' F�L1 "* <br /> r SCHdaULING MUST BE IYIADI^PRIORT03:00 P M.TF E DAY PRIOR 0EXP,J�CTED�AR rI II L ANY UNSCHEduLiD D AFIE SUBJECT <br /> m a Mev _ <br /> TO REFUSAL UPON ARRIVAL"ONGOING'DAELY DECiVERf S 11S'1�"� kE SCHEDULED V111TH THE LANi�I ,D& FARE, <br /> fiS4YF" �"+re ��` <br />