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❑fKeller Canyon ElOx Mountain [INewby Island Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary <br /> Landfill LaAdflil <br /> 901'aa" osd 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> P)tfsbu CA 94565 Half Moon Bay, CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> -,,,Phone (925)45849800 Phone($50)726-1819 Phone(408) 945-2800 Phone(209)982.4298 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408) 262-2871 Fax 1209}-982-1009 <br /> r NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR 4Y 0 c WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> y <br /> CITY, STATE, ZiIPREQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> C3GLOVES O GOGGLES CI RESPIRATOR 0 HARD HAT <br /> PHONE <br /> ❑TY-VEK ❑OTHER <br /> CONTACT PERSON - C SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE /' 0'-7'� f <br />' <br /> GENERATOR <br /> NERATOR S CERTIFICATION I hereby certify that the above named malenal is not a hazardous <br /> waste ei defined by 40 GFR Part 261 or title 22 of the California code of regulations has been properly <br /> described clarified and packaged and is in proper condition for transportation a-cording to appircable <br /> ragulations AND,If the weeks is a treatment residue of a pnwtousty restricted hetardous waste <br /> subtect to the Land Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Pan 268 and is no Ionger a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> O DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FAC LITY, <br /> Cu r <br /> TRANSPORTER J C ' eff NOTES I VEHICLE LICENSE NU ER TRUCK NUMBER <br /> ADDRESS <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE WAUTHORIZED AGqNT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> rCUBIC 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 /> Q SOIL <br /> REMARKS <br /> Q CONSTRUCTION <br /> I DEBRIS <br /> FACILITY TICKET N R QNON-FRIABLE <br /> ASBESTOS <br /> SIGNATU F AUTHORI ED AGENT DATE <br /> _ 1 Q WOOD <br /> ❑ASH <br /> ❑SPECIAL OTHER k { <br /> r ra, K <br /> {w��V3f h h , f - S H l,. : tit k`� 4 t t <br /> IN{US7'BE RlOIR7"O :DO P M.THE DAY PRIORTO� CP,ECI�EDARRI�AI.w`ANY UNSCH DULE4 L AD_S I SUBJECT <br /> �R I75AL'UPON #IRRIVAt_ }ONGOING RDAlt.1f DELlVERfES Mt ST BE $G� EOULEDiWIT ,, H,�*4 ' F L E D Y"8 � EY <br />