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❑ Keller Canyon ❑ OX Mountain ❑ Newby Island Forward <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 /> 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 /> J ', oA ufri v��✓�� as vy7o CtwTenC �sf <br /> MAILING ADDRESS <br /> r.,00 A!, 06CA'l 7 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> O GLOVES ❑GOGGLES ❑RESPIRAATOR HARD HAT <br /> PHONE $4FF7.1 �CiiI ES <br /> g - ❑TY-VEK BOTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> 20 <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR'S CERnFICATION:I hereby certify that the above named material is not a hazardous <br /> waste as defined by Q CSR Part 261 ar title M of the California code of regulations,has been property <br /> described,classifietl and packaged,and is in proper condition for transportation a%ordirg to applicable <br /> regulations;AND,If the waste Is a treatment residue of a previously restricted hazardous waste <br /> sublecl to the Wnd Disposal Resections,l certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with Me requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> O DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION O WOOD 6MW A72 06A4N D/Cr/G[- <br /> ❑DEBRIS ❑OTHER t <br /> txSPECIAL WASTE <br /> GENERATING FACILITY <br /> SAM 4_4� A84V <br /> TRANSPORTER 'A,. j M A-r" NOTES: VEHICLE LICENSE?NUMBERTRUCK NUMBER <br /> ADDRESS LMS f ��,�" � <br /> CITY,STATE,ZIP v� <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER JDATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> * 4R <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 DISPOSALMETHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> ❑ SOIL <br /> VFACILITY <br /> S <br /> ❑CONSTRUCTION <br /> TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> RE OFAUTHQEIFZEDAGENT DATE <br /> ❑WOOD <br /> 6 ASH <br /> ''� O SPECIAL OTHER <br /> Cr61PFA if 1NIr:4611 11-T RA M d11F PRlr1RT0.1-nn P M THF nAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br />