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0 Keller C;3nyon ❑ Ox Mountain ❑ Newby Island E--Orr yard <br /> r Stinitary 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 Halt 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 /> 11MGENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS j — <br /> y mss _ ,,c� , <br /> CITY, STATE,ZIP ,F E` - - REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ❑GLOVES ❑ GOGGLES ❑RESPIRATOR a HARD HAT <br /> PHONE ' <br /> ❑TY-VEK El OTHER <br /> CONTACT PERSON /t r r / r SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE ` <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous ' <br /> waste as defined by 40 CFR Part 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 resldue of a previously restrictad hatrandous waste <br /> subject to the Land Disposal Restnttlons I certify and warrant that the waste has been treated In RECEIVING FACILITY <br /> accordance with the requirements of 40 CFA Part 266 and is no longer a hazardous waste as defined by , <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> U DISPOSAL ❑SLUDGE <br /> L]CONSTRUCTION ❑WOOD 1 <br /> ID DEBRIS --D@ GTHER <br /> ©SPECIAL WASTE ,. <br /> GENERATING FACILITY _ <br /> TRANSPORTERa - NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> fes_. 7 �, r'� } _ t� <br /> ADDRESS <br /> CITY, STATE, ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER FDATE ROLL-OFFS FLAT-BED VAN DRUMS 1 <br /> CUBIC YARDS <br /> I hereby certify that the above named material has)been <br /> accepted and to the best of my knowledge the f rqp <br /> oing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate <br /> DISPOSE OTHER <br /> s ❑ SOIL <br /> EMARKS I <br /> l ❑ CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> L ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT t DATE <br /> ❑wooD <br /> ll L3 ASH <br /> 7�C ❑SPECIAL OTHER <br /> SCHEDUUNG MUST BE MADE PRIORTO 3.00 P M THE DAY PRIORTO EXPECTED ARRIVAL 9 ANY UNSCHEDULED LOADS ARE SUBJECE <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE <br /> 1.1 R <br /> MANIFEST <br />