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L} Keller Canyon L] Ox Mountain, to* ❑ Newby Island ❑ Forward <br /> Sanitary-Landfill - --Sanitary Landfill Sanitary Landfill Landfill <br /> 904 BAIley ad 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pitts6ura,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) 458-49861 Fax(650) 726-9183 Fax (408) 262-2871 Fax(209)9a2-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAL RESS X432 <br /> CI REQUIRED PERSONAL PROTECTIVE EOUIPMENT <br /> P107-21-011 U GLOVES U GOGGLES U RESPIRATOR U HARD HAT <br /> ❑TY-VEK U OTHER <br /> C N SPECIAL HANDLING PROCEDURES <br /> SIGNATL1093NTWB SM/WWENT DATE <br /> �C4 1&� <br /> BENE TlF I her rt t ed i of a hazardous <br /> waste as defined by 40 CFA Part 261 s 22 mlml� e n properly art <br /> described eiaasified and packaged a a in props itoK� nspoitatlon a xording to applicable <br /> regulstlom,AM if the wash Is a treatment issues oll a pmlously mWicted hazardous waste <br /> subject to the land Disposal Restrictions I certify and warrarlt that the waste has been treated in RECEIVING FACILITY <br /> aoccrdanoe with the reriinrements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> 10 CFR Part 261 <br /> WASTE TYPE <br /> O DISPOSAL O SLUDGE <br /> U CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> 7 ELEVEN#199t?8 13M NORTH MAIN STREET <br /> MANTS' PORTETI NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> AD we <br /> CI , <br /> PR%VtWrZfqIP,CA ON29 END DUMP BOTTOM DUMP TRANSFER <br /> SIMARIANKUTHORIZED AGENT OR DRIVER DATE - ROL F S FLAT-BED VAN DRUMS <br /> r <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been 18 YARDS <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 /> U SOIL <br /> REMARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER Zn. <br /> DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATU OFA QFQZEDAGE T ' DAT <br /> ❑WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> SCHEDULIN BE MAD RIORTO . P.M.THE DAY PRIORTO EXPECTED ARRIV4 a ANY UNPCHEDULED LOAD ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH E LANDFILL THE DAY BEFORE. <br /> SALES COPY MANIFEST#225111 <br /> 225111 ' <br />