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rorwara <br /> } Keller Canyon u ox mountainu NOWDY isianaLJ1 <br /> ' Sanitaryill Sanitary Landfilli fill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg,CA 94565 Half oony;CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone( )726-1819 Phone(408)945-2800 Phone(209) -4 <br /> 298 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax( )262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> FAILING ADDRESS ,5 1 <br /> 75 <br /> CITY,STATE,ZIP REQUIRIED PERSONAL POTTIVE E UIP <br /> U GLOVES U GOGGLES U RESPIRATOR RD HAT <br /> PHONE <br /> ==;30 ❑TY VEK UOTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> SI A UE3� F AUTHORIZED AGENT f TITLE DATE <br /> GENERATOR'S CERTIFICA •I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or Oft 22 of the calbmia code of regulations,has been property <br /> classified and paciaged,and is in proper condition tor transportation a-cordhV to applicable <br /> %If the waste is a tresummi residue of a previously restricted hazardous waste <br /> eubject to the Land Disposal Restrictions,I cerfily and warrant that an waft has bow treated in RECEIVING FACILITY <br /> accordance with the requirerngnte of 40 GFR Part 268 and is no longer a hazardous waste as defined 6Y <br /> 40 GFR Part 261. <br /> ATE PE: <br /> •DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION O WOOD <br /> U DEBRIS UOTHER <br /> O SPECIAL WASTE T t' ') <br /> GENERATING FACILITY <br /> TRA SPO TER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> w <br /> Ct ^,`STATE,Z <br /> POE END DUMP, BOTTOMDUMP TRANSFER <br /> E AGE OR DRIVER ATE ROLL-OFF(S) VAN DRUMS <br /> fri d ����{ "•ns/ <br /> K - <br /> CUBIC YARDS <br /> I hereby certifythat the abovenamed material has been <br /> accepted anto the best of my knowledge the foregoingDIS . (TO BE COMPLETED BYLANDFILL) <br /> is true andccu t . <br /> DISPOSE OTHER <br /> ®SOIL <br /> A S <br /> •CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENTD <br /> e O WOOD <br /> U ASH <br /> - o SPECIAL OTHER <br /> SCHEDULING U ADE PRIORT03:WP.M.THE DAY PRIORTO EXPECTEDARRIVAL-ANY UNSCHEDULED LOADSARESUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILYDELIVERIES UST BE SCHEDULED WITHTHE LANDFILL THE DAY BEFORE. <br />