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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward <br /> :unitary 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)45b-9891 Fax(650)726-9183 Fax(408}262-2871 Fax(209)982-1009 <br /> s <br /> NON-HAZARDOUS WASTE MANIF,EST - <br /> GENERAT R o 7 X WASTE ACCEPTANCE NO. <br /> C IZ-0 LJ AJ <br /> MAILING ADD ESS `{ <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> S F—` N C'T S Z GLOVES 0 GOGGLES 0 RESPIRATOR 0 HARD HAT <br /> PHONE <br /> 0 TY VEK 0 OTHER <br /> CONTACTPERSON F,4' � 1Jx#�_ c SPECIAL HANDLING PROCEDURES5,6 <br /> SIGNATURE OF UTHORIZED AGENT/TITLE DATE rt <br /> C <br /> Q4 o _ f �A z <br /> 2 7 �l <br /> GENERATOWS CEFtnRCATION I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 281 or title 22 of the California code of regulations has been properly ` <br /> described,classified and packaged and is in proper condition For transportation a-carding to applicable <br /> regulations,AN4 If the waste is a treatment residue of a previously restricted hazardous waste <br /> subject to the tend Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> a=rdence with the requirements 0140 CFR Part 269 and Is no longer a hazardous waste as dafined by LIT <br /> 40 CFR Part 281 U1 F <br /> WASTE TYPE <br /> ❑DISPOSAL 0 SLUDGE <br /> C7 CONSTRUCTION 0 WOOD <br /> 0 DEBRIS O OTH� <br /> 0 SPECIAL WASTE `! D t <br /> GENERATING FACILITY <br /> T NSPORTER NOTES VEHICLE LICENSE NUMBER TUCK NUMBER <br /> i 1 6 ' C.• <br /> r <br /> D RESS <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANS ER <br /> SIGNATURE OF AUTHORIZED AGEN ORD IVER DATE ROLL-OFFS FLAT-BED VAN D UMS <br /> i ❑ ❑ ❑ ❑ <br /> Jj1 i ��V r <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 DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> 0 SOIL <br /> REMARKS 0 CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBW 0 NON-FRIABLE <br /> ASBESTOS w <br /> ' SIGNATURE OF'At:i- RIZED AGENT DATE AWDDD <br /> VASHCIAL OTHER <br /> SCHEPULINd MUST FE-A&DE PRIORTO 3.00 PM THE*k PRIORTO E,X ECTED ARRIVAL-ANY-UNSCHEDULED LOADS ARE SUBJECT <br /> TO R9PU6AL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUSBE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> GENERATOR COPY MANIFEST# 287390-X <br />