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❑ Keller CaInyom,. ❑ Ox Mountain ❑ Newby Island <br /> • S.anitary Landfill Sanitary Landfill Sanitary ® Forward <br /> Landfill d Landfill <br /> 901 Salley Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pitt�owg,CA 94565 Half Moon Bay, CA 94019 Milpitas, CA 95035 Manteca, CA 95338 <br /> Phone(9`25) 458-9800 Phone(650) 726-1819 Phone(408)945-2800 Phone(209)982-4 <br /> Fax(925) 458-9891 Fax(650) 726-9183 Fax(408) 262-2871 Fax(209) 982-1 <br /> F <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY, STATE,ZIP , - ;} I. . REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE - � a GLOVES Q GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> CONTACT PERSON a� "TITLE <br /> D TYVEK 0 OTHER <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZEDDATE <br /> t <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 GFR Part 261 or bile 22 of the California code of regulations has been proper, <br /> described dassitied and packaged and m in proper condition for transportation a-i ordmg to appltcabie <br /> regulations AND If the waste Is a treatment residue of a previously restricted hazardous waste <br /> subisct to the Land Disposal Restrictions f certify and warrant that the waste has been treated In <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by DECEIVING FACILITY <br /> 40 CFF,Part 261 <br /> WASTE TYPE <br /> U DISPOSAL ❑SLUDGE <br /> Q CONSTRUCTION U WOOD <br /> ❑DEBRIS `p OTHER <br /> ❑SPECIAL WASTE ` <br /> GENERATING FACILITY <br /> Lr I 1 <br /> TRANSPORT ER777;1 — NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY, STATE,ZIP <br /> PHONE <br /> END DUMP BOTTOM DUMP TRANSFER _ - <br /> - <br /> SIGNATURE OF AUTHORIZEDAGENT_OR DRIVER DATE ROLL-OFFS FLAT-BED VANDRUMS <br /> 4 <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 0 SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENTDATE ASBESTOS <br /> , <br /> " ❑ WOOD <br /> ❑ASH <br /> ------------ <br /> 'f ❑ SPECIAL OTHER <br /> SCHEDUUNG MUST BE MADE PRIORTA 8.00 PM THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE <br /> @DAY BEFORE <br /> AAAMIMC'CT C 0 <br />