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Keilbr Canyon ❑ Ox Mountain nY ' ❑ Newby Island >Q Forward <br />' SInitary j-andflll Sanitary Landfill Sanitary Landfill '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-HAZARD01I6 WASTE MANIFEST <br /> GENERATOR Y WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> CITY, STATE,ZIP,. f _ r REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> GLOVES 0 GOGGLES O RESPIRATOR Q HARD HAT <br /> PHONE <br /> 0 Y-VEK G OTHER <br /> CONTACT PERSON ,� r L `s7-, SPECIAL HANDLING PROCEDURES <br /> 77 <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR S CERTIFICATION I hereby certlty 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 regulations has been properly <br /> described class€hed and packaged and is in proper condition for transportation a-cording to appii6f bfe <br /> regulations AND 11 the waste is a treatment residue at a previously raatrlctod hazardous waits <br /> subied to the Land Disposal Restrictions I certify and warrens that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements o1 40 CFR Part 266 and rs no longer a hazardous waste as defin"by <br /> 40 CFR Part 261 ' <br /> UWASTETYPE <br /> POSAL ❑SLUDGE <br /> NSTRUCTION a WOOD <br /> BRIS {&4.OTHER <br /> ECIAL WASTE ' <br /> GENERATING FACILITY <br /> r jj Y f <br /> ' NOTES VEHICLE LICENTRANSPORTER SE {N`UAA6ER TRUCK NUMBER W <br /> ADDRESS <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANS R <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> t s <br /> CUBIC YARDS <br /> I hereby certify that the above named material has bas r <br /> accepted and to the best of my knowledge the foregoin DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate. , <br /> t <br /> ij DISPOSE OTHER <br /> l <br /> l _ ❑ SOIL <br /> REMARKS i <br /> I 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER i DEBRIS <br /> © NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT TE <br /> r o WOOD <br /> r I ❑ASH <br /> i <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOBTO3 00 P M THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> Wo- REFUSAL UPON ARRIVAL.. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL,.THE DAY SEF RE <br /> MANIFEST # <br />