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❑ Keller Canyon ❑ O `',mritain u Newby lalar ` n Forward <br /> Sanitary Landfill S dry Landfill Sanitary fill Landfill <br /> 901 Bailey Road 12 San Mateo Road 1601 Dixon ng Road 9999 S.Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phohe(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 REQUIRED PERSONAS PROTECTIVE EQUIPMENT <br /> U;OLOVES O GOGGLES O RESPIRATOR 2HARD HAT <br /> PHONE <br /> O TY VEK O OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR's CERTIFICATION l hereby certify that die above named naterial Is not a hazardous <br /> waste as defined by 40 CFR Part 261 or Ode 22 of the California code of regultdions,has been property <br /> ossified and packaged,and is in proper condition for transportationaxording b applicable <br /> regulatrons;AND,K tlee waste Is•tresbrant rwldkw ota prwlousty restricted hazardous was% ' <br /> subject to the hand Disposal Restrictions.I oer*and warrant that the waste has been treated in RECEIVING FACILITY <br /> akx orda we with the requirements of 4o CFR Pert 266 and is no longer a hazardous waste as defined by tee <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> O DISPOSAL O SLUDGE v <br /> O CONSTRUCTION O WOOD C, <br /> O DEBRIS O OTHER L <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> sill I <br /> TRANSPORTER OTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY,STATE,ZIP ,- 777711_,3 7 _ <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> J <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> F-. <br /> i - <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 DISPO ETHOD: (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> REMARKS O CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICK UMB R O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATUBE OF AUTH RIZED AGENT DATE O WOOD <br /> ❑ASH <br /> O SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PR TO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST;BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> SAM 00" MANIFEST# 30542 <br />