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Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward <br /> Sanitary Landfill Sa&lry Landfill Sanitary "1111 Landfill <br /> 901 Bailey Road 12 Wan Mateo Road 1601-Dixon ,�`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 <br /> CITY,STATE,ZIP _ -,' REOUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> GLOVES O GOGGLES O RESPIRATOR HARD HAT <br /> PHONE s u <br /> ` O TY VEK O OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES:,. <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby oerlity that the above named material Is not a hazardous <br /> V <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regWatlona,has been properly <br /> described,classified andpackagedand Is in proper condition for transportation aging to applicable <br /> regulations;AND,H the waste Is a.trsabnerd resin of a previously restricted hazardous waste <br /> subject to the land Disposal Restrictions.I cerdty and watrart that#*waste has been treated In RECEIVING FACILITY wiaccordance th the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: `y <br /> O DISPOSAL O SLUDGE <br /> O CONSTRUCTION O WOOD <br /> O DEBRIS O OTHER -� <br /> O SPECIAL WASTE <br /> GENERATING FACILITY 4 <br /> TRANSPORTER` I < 1 ! .- �; i I c— NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS mac:. I:_u ,I`I/ r fit '/ �' <br /> CITY,STATE,ZIP <br /> PHONE -7 END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> 1 <br /> CUBIC 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 /> O SOIL <br /> REMARKS <br /> O CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> O ASH <br /> O SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 300 P.M.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> S,&ES GAY MANIFEST# 0 5 4 0 <br />