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' �] Keller Canyon < ❑ ®�Mountain ❑ Newby Island ��Fo�'�+a� <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310�an Mateo Road 1601 Dixon landing Road 9999 S Austin Road <br />' Ptttsburg,CA 94565 Half Moon Balm,, CA 94019 Milpitas,CA 95035 Manteca, CA 95336 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! NII=l4ST <br /> tENERATOR/ r _' �- f WASTE ACCEPTANCE NO. <br /> fILING ADDRESS _G TY, STATE,ZIP <br /> - REQUIRED PERSONAL. PROTECTIVE EQUIPMENT <br /> 7; O GLOVES I GOGGLES a RESPIRATOR d HARD HAT <br /> t0HONEC. <br /> ❑TY-VEK ❑OTHER <br /> NTAPERSONSPECIAL HANDLING PROCEDURES <br /> GNATURE OF AUTHORIZED AGENT/TITLE DAT1w <br /> GENERATOR 5 CERTIFICATION I hereby certify that the above named matenal Is not a hazardous <br /> waste as defined by 40 CFR Part 261 or true 22 of the California code of regulations has been property <br /> described classified and packaged and is in proper condition for transportation a-cording to applicable <br /> regulations AND,It the waste is a treahmmt reetdue of a ptsvltsusty restricted hazardous waste <br /> subject to the Land Disposal Restrictions I certify and warrant that the waste has been!reeled rnRECEIVING FACILITY <br /> accordance with the requirements of 46 CFR Part 268 and is no longer a hazardous waste as del ned by <br /> 40 CFR Part261 <br /> WASTE TYPE <br /> d DISPOSAL U SLUDGE <br /> ❑CONSTRUCTION O WOOD <br /> ❑DEBRIS PVTFJER <br /> d SPECIAL WASTE <br /> GENERATING FACILITY <br /> �� ' ' <br /> ' ' �t' <br /> r <br /> TRANSPORTER �9 _ NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> AF- <br /> ADDRESS <br /> 7-7 7 <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ❑ U ❑ C� <br /> �pi- <br /> 77- <br /> CUBIC YARDS <br /> I hereby certify that the abode 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 /> U SOIL <br /> REMARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUT)i©RAZED AGENT DATE <br /> ❑WOOD <br /> 3 ASH <br /> 7�C ' <br /> AK/7--1 0 SPECIAL OTHER <br /> 1SCHEDULING MUST BE ADZE PRIO'RTO 3 IIS I-M THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES FUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> MANIFEST 0 9 <br />