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' ❑ Keller Canyon , " [} Ox Mountain ❑ Newby Island [],Forward <br /> Sanitary Landfiilx Sanitary Landfill Sanitary Landfill Landfill <br />' <br /> 9%Bailey•Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Half Ammon Bay, CA 94019 Milpitas, CA 95035 Manteca,CA 95336 <br /> Phone (925)458-9800 Phone (65d),Y26-1819 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 /> GENERATOR f - WASTE ACCEPTANCE NO. <br /> , r <br /> MAILING ADDRESS , <br /> CITY, STATE,ZIP- ,, REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 0 GLOVES a GOGGLES ❑RESPIRATOR 0 HARD HAT <br /> PHONE <br /> 11111111 ❑TY-VEK L3 OTHER <br /> CONTACT PERSON , <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATQR 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 Califomra code of regulations hes been properly <br /> desonbed classified and packaged and ro in proper sand iron for transportation a^cording to applicable <br /> regulations AND,if the waste is a treatment residue oS a prwviousty restricted hazardous waste <br /> subject to tho Land Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance w8h the requirements of 40 CFR Pari 2613 and is no longer a hazardous waste as defined nyr <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> O DISPOSAL O SLUDGE <br /> U CONSTRUCTION Q WOOD <br /> Q DEBRIS OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> r <br /> s w € <br /> TRANSPOR�Tr Eff`µ• NOTES iVEHICLE <br /> _�LtII+C.{E�Ny SEiS <br /> NUMBER 1' ` T�R—'TU_CK�Nf UMB. <br /> ER <br /> SADDRES <br /> _r1 oi✓ ,c1 r ! _ ) ! w: 1 <br /> CITY, STATE,ZIP t t�, a , ``_;;A <br /> PHONE I i ? 17 7, END DUMP BOTTOM DUMP TRANSFER <br /> ❑ -. <br /> SIGNATURE OF AUTHORIZED.AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN 'DRUMS <br /> U L11 ❑ <br /> CUBIC YARDS <br /> I hereby certify that the abode named material has been <br /> accepted and to the beat of my Knowledge the foregoing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate <br /> DISPOSE OTHER <br /> Q SOIL <br /> 0WREMARKS <br /> C]CONSTRUCTION <br /> - DEBRIS <br /> FACILITY TICKET NUMB fi ❑ NON-FRIABLE <br /> ASBESTOS <br /> IGNATUR OFAUTHORIZED'AGENT DATE <br /> ❑WOOD <br /> I � <br /> ❑ASH <br /> t ff ❑SPECIAL OTHER <br /> IFiEDUL5MG MUST BE MADE PRIORTO 3 00 P M THE DAY PRIORTO EXPECTED ARRIVAL,,ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARR1 Ai_SthG0lNG DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY SEFORE <br /> A 0a l 0% R1A <br />