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❑ Keller Capyoff . ❑ Ox Mountain ❑ Newby Island [ 'Forward <br /> tSanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> .601 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 /> Y <br /> GENERATOR S : `t "'� e WASTE ACCEPTANCE N0. <br /> `w <br /> MAILING ADDRESS 1 4It€� <br /> CITY, STATE,ZIP ` .; < �1 ' �` REQUIRED PERSONAL PROTEC VE EQUIPMENT <br /> PHONE Y !! 'JGLOVES ❑GOGGLES 0 RESPIRATOR Ca HARD HAT <br /> y t R D 1'\r-VEK U OTHER <br /> CONTACT PERSON f SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR 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 California code of requisitions has been property <br /> described classified and packaged and is m proper condition for transportation a-comdnng 10 applicable <br /> regulations AND,If the waafo In a treatment residue of■previously restricted hazardous waste <br /> sabject to the Land Dispose:Restnctiom I certify and warrant that the wasis has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as deftned by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> 0 DISPOSAL ❑SLUDGE <br /> 0 CONSTRUCTION ❑WOOD <br /> Q DEBRIS U'OTHER <br /> O SPECIAL WASTE ` <br /> GENERATING FACILITY , <br /> G <br /> TRANSPORTER NOTES VEHICLE LICENSE;NUMBER TRUCK NUMBER <br /> ADDRESS <br /> Y � r <br /> CITY, STATE,ZIP <br /> PHONE �� I _ '- r END DUMP BOTTOM DUMP TRANSFER <br /> ` ❑ ❑ JD <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF=S FLAT-BED VAN DRUMS <br /> �4Z <br /> CUBIC YARDS <br /> Flherceby certify that the above named material has been <br /> ted 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 /> ❑ SOIL <br /> =IREMARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE7AH�ORIZED AGENT DATE <br /> U WOOD. <br /> {/ =a � ( ?I ❑ASH <br /> 1 ❑SPECIAL OTIiER <br /> F <br /> HEDULING MUST UE MAtDEt PRIOR TO 3 00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> REFUSAL UIPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> aae�necccr x <br />