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Keller Canyon a❑Co ❑Ox Mountain <br /> El Newby Island LJ Fofuvard <br /> I!, ganitar .Landfill Lal Sanitary Landfill .Sanitary Landfill Landfill' <br /> i 901 Bailey Road 289, ;de Road 12310 San Mateo Road 1801 Dixon Landing Road 9999 S:Austin Road <br /> Pittsburg, CA 94565 Corr )7330 Half Moon Bay,CA 94019 Milpitas,CA"95035. Manteca, CA 955336 <br /> 4 .Phone(925)458-9800 Phone(541)745-2018 Phone(650).726-'1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(925)458-9891 Fax(541)745-3826 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> AV <br /> GENERATOR WASTE ACCEPTANCE NO.' <br /> Hcadrt11.er Rapmax t <br /> MAILING.ADDRESS <br /> 6939 <br /> CITY,STATE,ZII? :'°° " REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE GLOVES ©GOGGLES ❑RESPIRATOR X3 HARD HAT <br /> Z4 •OCk?5 ❑TY-VEK ❑ SAFETY VEST <br /> CONTACT PERSON 1 <br /> SPECIAL HANDLING PROCEDURES: <br /> Brdt.cowsm <br /> SIGNATURE OF AUTHORIZED AGENT I TITLE DATE <br /> GENERATOR'S CERTIFICATION:I hereby certify that the ab04 named material Is not a hazardous' " <br /> waste as defined by 40 CFR Part 261 or title 22 oT the California code 61 regulations,has been properly, <br /> described,classified arid packaged,and Is in proper condition for transportation a-.cording to applicable' <br /> regulatlons;AND,It the waste Is a trestinent residue of a Previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in <br /> accordance, ith the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined byRECEIVING FACILITY <br /> " <br /> 40 CFR Ran 261. <br /> WASTE TYPE: <br /> i DISPOSAL ❑SLUDGE <br />!, ❑CONSTRUCTION ❑WOOD <br /> I n DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE — – - — <br />{ = GENERATING FACILITY <br /> 2025 VVI Hazelton Ave S'I't7f-WI'T N <br /> I TRANSPORTER NOTES: "VEHICLE LICENSE NUMBER ,TRUCK NUMBER <br /> W.T"idEer ADDRESS 1p Q" ! <br /> 2710 L+amliff Rte i+ <br />° CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM-DUMP 7RAN FER <br /> (ZOr 45&)145 . <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER: DATE ROLL-OFFS FLAT-BED VAN ' DRUMS <br /> CUBIC YARDS <br /> hereby certify that the above named material,has been <br /> accepted and to the beat of m knowledge the foregoing <br /> y 9 9 9 DISPOSAL METHOD: W0, <br /> is true and accurate. O {TO t3E CO ;LET D BY LANDFILL) <br /> DISPOSE .OTHER . <br /> .❑SOIL <br /> EMARKS <br /> U.CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> 4 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTH RIZED AGENT DATE <br /> f G WOOD <br /> �! ❑.ASH <br /> / LL11 I �J <br /> 0 SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:04 P.M.THE DAY PR.IORTO EXPECTED ARRIVAL•ANY UNSCHEDULED,LOADS ARE SUBJECT <br /> 1O-REFUSAL UPON ARRIVAL. ONGOING DAILY"DELIVERIES. MUST"BE SCHEDULED WITH THE LANDFILL.THE DAY BEFORE.' <br /> p GENERA TO(4;COPY MANIFEST## 6 49 8 <br />