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❑ Keller Canyon ❑ x Mountain ® Newby Is? � Forward <br /> SAnlitary Landfill S ary Landfill Sanitary fill. Landfill <br /> 901 Bailey Road 12 San Mateo Road 1601 Dixon La ng Road 9999 S.Austin Road <br /> Adtsburg,CA 94565 Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone 4925)458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax J925)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 I <br /> 9 <br /> 1 CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> O-GLOVES 0 GOGGLES 0 RESPIRATOR Cr1 HARD HAT <br /> 1 PHONE r' <br /> 0 TY VEK 0 OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby cer*that the above named material Is not a hazardous <br /> waste as defined by 40 CFR Pert 261 or title 22 of the California code of regulators,has been property <br /> described,clasalled and Packaged,and is in proper corMon for transportdon according to appficable <br /> regulations:AND,N the watt®in a bustment roekko of a prwvbwly restricted hazardous waw <br /> subject to the,Land Disposal Restrictions,I earthly and warrant that the waste has bow treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 286 and m no longer a hazardous waste as defined by <br /> 1 40 CFR Part 261. <br /> WASTE TYPE: C <br /> 0 DISPOSALO SLUDGE <br /> 1 0 CONSTRUCTION, O WOOD D DEBRIS 0 OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY it <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> 1 ADDRESS r <br /> CITY,STATE,ZIP 77-77`� .. <br /> 1 PHONE - ! 1 END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ' - CUBIC YARDS <br /> 1 hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METRO®: (TO BE COMPLETED BY LANDFILL) <br /> 1 is true and accurate. <br /> DISPOSE OTHER <br /> 0 SOIL <br /> 1 <br /> REMARKS <br /> 0 CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKEr NUMBER O NON-FRIABLE <br /> 1ASBESTOS <br /> SIGNATURE OFAS NT DATE <br /> i O WOOD <br /> ZU ASH <br /> PEC ®TREK <br /> SCHEDULING MUST BE MADE PR TO 3:00 RM.THE DAY PRIORTO EXIOECTED ARRIVAL•ANY UNSCHEDULED ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE <br /> 3 3 BEFORE.RE. <br /> MANIFEST• <br /> QAI VA MPv <br />