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El.Keller Canyon ❑ Ox Mountain,i ,� ❑ Newby Island ❑ Forward <br /> roalfitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 90'1 � y Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pitts4'y <br /> ;CA 945125 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 /> MATILM,GMR16RESS <br /> CI 2 110 REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PH ?622143q 11 Q GLOVES U GOGGLES U RESPIRATOR 0 HARD HAT <br /> U TY-VEK U OTHER <br /> COFMef0PWMF N SPECIAL HANDLING PROCEDURES <br /> SI / DATE <br /> Q CE I ! ON I eby rtity that above named ma erlei hot a hazardous <br /> waste ae defined by 40 CPR Pah title 22 of th allfom a code regi been properly <br /> desorlbed,daesMe end and Is In props d ng to applicable <br /> regulations,AND,H IM waste Is a treebnert ua of P restricted hazardous waste <br /> subject to the Land Disposal Restrictions 1 cerci and wart m the waste has been treated in RECEIVING FACILITY <br /> acoordance Wth the requirements of 40 CFR P 268 end longer a hazardous wasw as delkred by <br /> 40 CFR Part 281 <br /> WASTE TYPE <br /> ❑DISPOSAL ❑SLUDGE ' <br /> U CONSTRUCTION Q WOOD _ <br /> ❑DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> 7 ELEVEN#19078 1599 NORTH MAIN STREET <br /> kNNSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> AD <br /> CI , <br /> P eA 95e29 END DUMP BOTTOM DUMP TRANSFER <br /> SI UTHORIZEDAGENT OR DRIVER DATE ROLL S FLAT-BED VAN DRUMS <br /> ❑ ❑ U (3 <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been 18 YARDS <br /> accepted and to the-bit cf my kWWWg�`ttFeToregoing <br /> is true and accurate. DISPOSAL METHOD OBE COMPLETED BY LANDFILL) <br /> 4 <br /> r <br /> DISPOSE OTHER <br /> REMARKS U SOIL , <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> SlGNATU OFA HORIZED AG T DATE ASBESTOS <br /> U WOOD <br /> O ASH <br /> U SPECIAL OTHER <br /> SCHEDULING NNI&M M IORTO P.M.THE DAY PRIG TO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> SALES COPY MANIFEST#225110 <br />