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El Keller Canyon ❑ Ox Mountain E] Newby !eland �-Forward <br /> Sanitary 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 Haff 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 /> ak <br /> NON-FIAZARDOUS WASTE MANIFEST <br /> GENirRATOR , <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> rP <br /> ITY, STATE,ZIP f'" ,- r___ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 7 ' �` r 1 y f`— Q GLOVES O GOGGLES ❑ RESPIRATOR L)HARD HAT <br /> i 3 <br /> HONE ' , <br /> ❑TY VEK C9 OTHER � <br /> CONTACT PERSON <br /> r r sj f_f , f r e SPECIAL HANDLING PROCEDURESSkGNATURE OF AUTHOREZED AGENT l TITLE DATE <br /> GENERATOR S CERTIFICATION I 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 of rogutations has boon property <br /> described classified and packaged and is in proper condition for transportation a-cording to applicable <br /> regulations ANDi It the waste Is o treatment residua of a previously restricted hin ardous woute <br /> subfaet to the Land Disposal Restrictions I certify and warrant that the waste has been treated at RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no ionger a hazardous waste as defined by1 <br /> 40 CFR Part 261 s <br /> V <br /> TYPEPOSAL 0 SLUDGE <br /> NSTRUCTION ❑WOOD <br /> BRIS fJT¢iER <br /> CIAL WASTE <br /> GENERATING FACILITY <br /> j <br /> TRANSPORTER — - _ NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> V lc-J <br /> ADDRESS <br /> SS <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE;OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BEES VAN DRUMS <br /> s .` <br /> s <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 /> EMARKS ❑ SOIL <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> 0 NON—FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> 0 WOOD <br /> 'f CI SP CI`AL OTHER <br /> HEDULik MUST BE MADE PRIORTO 3 COP M.THE DAY PRIORTO EXPECTED ARRIVAL m ANY UNSCHEDULED LOADS ARE SUBJECT <br /> REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES V UST BE SCHEDULED WITH THE LANDFILL TETE DAY BEFORE <br /> MANIFEST 0 A q 7 <br />