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L_t Keller Canyon H Ox Mountiln ❑ Newby Island ® Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Salley 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)4.58-9891 Fax(650)726-9183 ` ' Fax(408)262-2871 Fax (209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> Chevron #9-0557 <br /> MAILING ADDRESS <br /> P.O. Box #6004 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Eamon, CA 94583 D GLOVES 0 GOGGLES 0 RESPIRATOR ❑HARD HAT <br /> PHONE <br /> —942-8955 ❑TY VEK (MOTHER Level D <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> Tornoelon for Robert Cochran <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> -tan: �, 4 l.�a.8-Co 31 l°3 <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above naffed material is not a hazardous <br /> waste u defined by 40 CFR Part 26t or Uds 22 of the California code of regufabons,has been property <br /> described.classified and packaged,and is in proper condition for transportaboo according to applicable <br /> regulations:AND,If the waste is a treatment residua of a previously restricted hazardous waste <br /> subject to the land Oaposal Resulctior»,I certity and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 269 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> C1 DISPOSAL 0 SLUDGE <br /> •CONSTRUCTION a WOOD <br /> ❑DEBRIS D OTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY <br /> Chevron #9-0557 <br /> '1 I q C,r) t^ . f?P.t' St nn <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> IMInc. �� �� v2 5 <br /> ADDRESS <br /> 950 Ames Avenue <br /> CITY, STATE,ZIP <br /> Mil itas CA 95035 <br /> PHONEEND DUMP, BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ <br /> PCIUBIC YARDS <br /> I hereby certify that the above named material has been + 20 CY- <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 /> O SOIL <br /> EMARKS <br /> 0 CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AVT1-IORIZE0A0EN i DATE O WOOD <br /> r, <br /> . 7 <br /> O ASH <br /> SPECIAL-OTHER <br /> SCHEDULING MUST 8E MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFLt9At,:UPQW3A1MML. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAYBEFORE. <br /> MANIFEST M 44409 <br />