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• ❑-Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward <br /> 'Sanitary L,andfilf Sanitary Landfill Sanitary Landfill f Landfill <br /> 901 Bailey 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) 982-4298 <br /> Fax (925)458-9891 Fax (650) 726-9183 Fax(408) 262-2871 Fax(209) 982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR - WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS / ;, ,, / 1 <br /> CITY, STATE, ZIP- REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE C,1 GLOVES U GOGGLES Q RESPIRATOR U HARD HAT <br /> U TY VEK U OTHER <br /> ISIGN <br /> ONTACT PERSON , „� r <' <br /> 11-//- E r { K SPECIAL HANDLING PROCEDURES <br /> ATURE OF AUTHORIZED AGENT/TITLE DATE <br /> tdeacdbed <br /> OR s CERTIFICATION I hereby certify that the above named material Is not a hazardous <br /> efined by 40 CFR Part 261 or htle 22 of the California code of regulations has been property <br /> classified and packaged and min proper condition for transportation a^cording to applicable <br /> s ANO,If the waste is a treatment residue of a previously restricted hazardous waste <br /> the land Disposal Restrictions I certify and warrant that the waste has been treated toRECEIVING I*ACILITY <br /> e vnth the requirements of 40 GFR Part 266 and is no longer a hazardous waste as defined byart 261 <br /> WASTE TYPE <br /> Q DISPOSAL U SLUDGE <br /> U CONSTRUCTION ❑WOOD <br /> U DEBRIS 1Q ?�HER <br /> U SPECIAL WASTE <br /> ° "` <br /> GENERATING FACILITY <br /> RANSPORTER)` }F 1 _ NOTES VEHICLE LICENSE N nMBER TRUCK NUMBER <br /> P <br /> CITY, STATE,ZIP <br /> PHONE £ ;n c END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE AUTHORIZED AGENT•OR DRIVER DATE ROLL-OFFS Ft AT-BED VAN DRUMS <br /> 7�C y fru , <br /> 4 <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 /> U SOIL <br /> U CONSTRUCTIONJEMARKS <br /> ACILITY TICKETNUMBERDEBRIS <br /> U NON-FRIABLE <br /> ` ASBESTOS <br /> IGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> HEDULIN G MUST BE MADE kIORTO 3 COP M THE DAY PRIOR TO EXRECTED ARRIVAL*ANY UNSCHEDULED LADS ARE SUBJECT <br /> REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST 13E SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> t, MANIFEST 6 A A Q <br />