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❑ Keller Canyon ❑ Oountain E] Newby Isld [Forward. <br /> Sanitary. Landfill .Sanitary Landfill Sanitary Landfill landfill <br /> 1.901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing 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 /> JAV <br /> )Lfrq fs =Cu?D 1 AM4 69*4MD /S . <br /> MAILING ADDRESS _ <br /> �� A7 <br /> CITY,STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> U GLOVES 0 GOGGLES U RESPIRATOR I;ICHARD HAT <br /> PHONE cltw6D <br /> 0 TY-VEK %OTHER <br /> CONTACT PERSON OSPECIAL HANDLING PROCEDURES: <br /> s7e a <br /> SIGNATURE OFAUTHORIZED AENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby cerci4 that the above named material is not a hazardous <br /> waste as banned by 40 CFR Part 261 or its 22 of the California code of regulations,has been property - <br /> described,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> regulations;AND,If the waste Ie-e treetmant ruldue of a Previously natdcW ha to dous waste <br /> subject to the landDisposal Restrictions,l cenity and wanant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirementsof 40;CFR Pan 266 and.is no longer a hazardous waste as defined by <br /> 40 CFR PaA 261. <br /> WASTE TYPE: <br /> 0 DISPOSAL 0 SLUDGE <br /> ❑CONSTRUCTION a WOOD n,TtvR21), -'SNC. 411MO6//1 <br /> 0DEBRIS 0OTHER - I31AN%ECA) Gi . <br /> P(SPECiAL WASTE. <br /> GENERATING FACILITY <br /> TRANSPORTER I !f} fA A,- NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS C91 VJi\It vA. 1 ?v <br /> CITY,STATE,ZIP G S2U <br /> PHONE 74tt:1 J -t D 04S5 END DUMP BOTTOM DUMP TRANSFER <br /> ❑ �ar <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> _,,33�_ ❑ ❑ ❑ ❑ <br /> y- b-oy <br /> I <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been Z <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> u DISPOSE OTHER <br /> '~• 0 SOIL <br /> REMARKS '. <br /> N 0 CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENTI (DATE 0 WOOD <br /> 0 ASH <br /> t 0 SPECIAL OTHER <br /> 4EDUUNG MUST BE MADE P910RTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br />