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F7 Keller Canyon <br /> ❑ qt{, in [DNewby Isl�Fid ❑ Forward <br /> Sanitary Landfill SanitaMLandfill Sanitary Landfill Landfill <br /> 901 Bailey Road 1231'Q Sas 1M o Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg,CA 94565 Half Mpon Bay jCA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone (925)458-9800 Phone 6 7 6-1819 Phone(408)945-2800 Phone(209) 982.4298 <br /> Fax(925)458-9891 Fax(6 9183 Fax(408)262-2871 Fax (209) 982-1009 <br /> \� �j <br /> NOS"' AZARDOUS WASTE MANIFEST <br /> GENERATOR / WASTE ACCEPTANCE NO. <br /> �� r 1, I I 10 CQ n170T <br /> MAILING ADDRESS f _ <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE L Q I ❑GLOVES ❑GOGGLES gRE'2LRAT0 0 HARD HAT <br /> S YF G�,� SYS <br /> OTY-VEK OOTHER ,f,�/• )��7 S O� � <br /> CONTACT PERSON ' <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED' GENT/TITLE DATE <br /> v -p 1Z �I_ ho'o OW�at- <br /> * ,411 A Lir �7-c7 <br /> GENERATOR'S CERTIFICATION:I hereby certify,that the above named material is not a hazardous <br /> waste as defined by 40 CFR part 261 6f Htle 22 of the California code of regulations,has bean properly <br /> described,classified and packaged,and Is In proper condition for transportation a-cording to applicable <br /> regulations:AND,If the.weete Is a tratrnent residue of a previously restricted hazardous waste <br /> subject to the Land DispadayRestriclions,i cerliy,and warrant that the waste has been treated in RECEIVING'FACILITY <br /> accordance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> 40 CFR•pert 261. <br /> WASTE TYPE: <br /> 0,DISPOSAL ❑SLUDGE ^ <br /> ❑CONSTRUCTION - ❑WOOD a a% Mj <br /> DEBRIS <br /> O DEBRIS ❑OTHER-CkS /9 1 <br /> PECIAL WASTE i <br /> GENERATING FACILITY <br /> TRANSPORTER rN, /,t9- I i�U J7 t-11Al(-,, NOTES: VEHICLE LICENSENUMBERTRUCK NUMBER <br /> ADDRESS C `� 7 <br /> `5`•� / '0 3 <br /> CITY,STATE,ZIP` <br /> PHONE END DUM BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER . DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> ff ❑ ❑ ❑ ❑ <br /> �k n?V ti z��91 co D7 O <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been /49 <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 /> ❑SOIL <br /> REMARKS <br /> ❑CONSTRUCTION <br /> EFACILITYTICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> E OFAUTHORJZED AGENT PATE p WOOD <br /> a SH <br /> !/i % ✓ i <br /> C3 SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br />