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`❑ Keller Canyon- ❑ Ox Mountain ❑ Newby Island ❑`Forwoard <br /> S,1:iitary.Landitll , T" Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Batey 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)982-429l�� <br /> Fax(925)458-9891 Fax (650) 726-9183 1 Fax(408)262-2871 Fax(209) 982-1 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY STATE, ziP. REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 77 <br /> r r f <br /> PHONE U GLOVES O GOGGLES 0 RESPIRATOR ©HARD HAT <br /> U TY VEK Q OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATORS CERTIFICATION I hereby codify that the above named material Is not a hazardous - <br /> waste as defined by 40 CFR Part 261 or @tie 221 of the California code of regulations has been properly ' <br /> descnbed classified and packaged and is in proper conditions for transportation a-cording to applicable <br /> regulations AND t}the waste Ise traetraant residua of a previously restrlated hazardous waste <br /> subject to the land Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> acoordance with the requirements of 40 CFR Part 268 and Is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ❑DISPOSAL la SLUDGE <br /> Q CONSTRUCTION O WOOD <br /> U DEBRIS 4,071!ER <br /> G SPECIAL WASTE <br /> GENERATING FACILITY <br /> it <br /> TRANSPORTER - , NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS -{ - F � '� i ; #--_r, 4 <br /> CITY, STATE,ZIP <br /> PHONE l�-�� d_1 ..� � � END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT CSR DRIVER -- Y DATE _l ROLL-OFF(5 FLAT-BED VAN ----- RUMS ^ M <br /> , CUBIC YARDS <br /> 1 hereby certify that the above named material has been <br /> - accepted and to the best of my knowledge the foregoing <br /> Is true and accurateDISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) 4 - <br /> DISPOSE OTHER <br /> EMARICS a SOIL <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF-AUTHORIZED AGENT; DATE <br /> ! U WOOD <br /> GASH <br /> ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PAORTO 3.00 P M THE DAY PRIOR TO EXPECTED ARRIVAL.a ANY UNSCHEDULED LOADS ARE SUtBJ E <br /> TO REFUSAL UPON ARRIVAL,.. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEF RE <br /> MANIFEST It 4 R 4 R <br />