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Keller Canyon ❑ Ox Mountain LI Newby Island .Fdrward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pltts�r CA 94565 Half Moon Bay,.CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> e�92 <br /> Phon5)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 /> GEN.Ef3ATOR WASTE ACCEPTANCE N0: <br /> MAILING ADDRESS <br /> 11*val SUp W4A 431-4 <br /> CITY,STATE,:ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> att Brmuco'CA4120 U GLOVES U GOGGLES O RESPIRATOR O HARD HAT <br /> PHONE <br /> U TY-VEK U OTHER <br /> fONTACT PERSON <br /> JRa�=Gra ' SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> ENERATOR'S CERTIFICATION:I hereby that the above named material is not a hazardous <br /> ;yvaste as defined by 40 CFR Part 261 or title 22,of the Califomia code of regulations,has been properly <br /> tlBSctibed,class f ed and packaged,and is n proper condition for transportation a cording to applicable <br /> talions;AND,M the weals is a treatment residue of a previously restricted hazardous waste -- <br /> su�egtto the Land Disposal Plestrictioni,1-certity,arid warrant that the waste has been treated in RECEIVING FACILITY <br /> <eccoidance with the requirements 0140 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> A E TYPE: <br /> .r ISPOSAL U SLUDGE <br /> U CONSTRUCTION. U WOOD <br /> �s O DEBRIS U OTHER <br /> 411, <br /> U SPECIAL WASTE <br /> ENERATING FACILITY <br /> Uelxyclra#tc; tet LAI'HROP <br /> t <br /> NOTES: VEHICLE LICENSE NUMBER " " TRUCK NUMSER' <br /> . Tia>�rd�icxi <br /> e cpm <br /> ITY,STATE,ZIP I <br /> a ; PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 838-1407 ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROL -OFF(S) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <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 /> U SOIL <br /> REMARKS U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> ,I <br /> U ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 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 /> GENERATOR COPY MANIFEST# R 1 <br />