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U ox mountain Lj meway isiana U rorwara <br /> - "'Keller Canyon dfiLandfill <br /> Sanitary Landfill San" Landfill 1601 Dixon LandiSanitary Lanng Rll Road 9999 S.Austin Road <br /> 901 Bailey Road 12310 San Mateo Road Manteca,CA 95336 <br /> Pittsburg,CA 94565 Half Moon Bay, 94019 Milpitas,CA 95035 <br /> Phone(925)458-98W Phone -7t6-1819 Phone(408)W-2800 Phone(209)982-4298 <br /> 0 Fax(925)458-9891 Fax(65000726-9183. Fax(408)262-2871 Fax(209)962-1609 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO._ <br /> MAILING ADDRESS <br /> REQUIRED PERSONAL PROTECTIVE EQUIPMENT.— <br /> STATE,ZIP a GLOVES u GOGGLES a RESPIRATOR QHARD HAT <br /> PHONE a TY-VEK 0 OTHER <br /> t. ..q- <br /> CON'{A <br /> - <br /> T PERSON SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OFAUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERT MAnom I henft cww ow ft aw-named material is not a ftanious <br /> waste as defined by 40 GFR Pad 261 or W 22 d the WkA-ft cOdO 0i ragulsfions.has bear,pwpsdy <br /> classmed and padwood,and is in p6per condition for vanspomabon vowding to vppowwe <br /> -�AKIO.It tive wmt*Is ft uss"Reat weldwal a Previously reabidw heawdous Weals <br /> . toun;Land DisposaiReorldbm I veggy and www1matowwasW has bow bestedin RECEIVING FACILITY <br /> acmdance wm an requkemerft d 40 CFR Pat 2W end is no bwr a hazemiRm waste as dafined by <br /> 4DCFR Part 261. <br /> WASTE TYPE: <br /> U DISPOSAL 0 SLUDGE <br /> 0 CONSTRUCTION U WOOD <br /> 0 DEBRIS UOTHER <br /> 0 SPECIAL WASTE 'y I <br /> GENERATING FACILffS' <br /> Jill <br /> TRANSPORTER NOTES: VEHICLE LICENSE NTRUCK NUMBER <br /> —I( Q <br /> A <br /> ADDRESS <br /> STATE, 0P <br /> E END DUMP- BOTTOM DUMP TRANSFER <br /> SIWMREO AUTHORIZED OR DRIVER DATE ROLL FF@) FLAT-BED VAN DRUUMS <br /> Ll <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. DISPOSE OTHER <br /> U SOIL <br /> ffEMARKS U CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE 67F—AUTHORIZED AGENT —DATE ' Lk WOOD <br /> 0 ASH <br /> Q SPECIAL OTHER <br /> IN I ARRIVAL 0 ARE SUBJECT <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.T"E DAY pRIORM EXPECTED ANY UNSCHEDULED 0 LOA S E E <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> 6 -d 80*113-698 OWIWOlUd N313d e86 :L0 So 22 2nd <br />