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`❑ Keller Canyon - ❑ Ox Mountain ❑ Newby Island _ J r p Forward <br /> SarYitary Lan4f111� ' Sanktary Landfill Sanitary Landfill a 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 /> Phonlr�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 /> • ` <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERAT R o x f C o Y WASTE ACCEPTANCE N0. <br /> o FAAjIC6 W A/ <br /> MAILING ADDRESS I _ J�� <br /> `� <br /> CITY, STATE, ZIP _ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> i6-14_ <br /> PHONE &GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> U TY VEK O OTHER <br /> CONTACT PERSON 74 Ft- Jacy rU 5r�9- 3-33 g SPECIAL HANDLING PROCEDURES <br /> _ <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE /11,45L ,�a.t.1 /, /4 hIJA 71;_ ���► l 4- <br /> GENERATORS <br /> GENERATOR'S CERTIFICATION I hereby certily that the above named material Is Trot a e <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of mgulaflons has been p r1 <br /> described classified and packaged and Is in proper condition for transporlatiorr -cordl to appl e <br /> regulations,ANI],If the waste le a Uealment midus of■previous puskwksate 1 <br /> subject to the land Disposal Restrictions,I certify and warrent that the to has been lad In WING F ILITY � f <br /> accordance with the requirements of 40 CFR Part 266 and Is no longer a hazardous waf;le ldeftned by f-_Le_ /r X� <br /> 40 CFR Part 261 <br /> WASTE TYPE i <br /> ❑DISPOSAL ❑SLUDGE <br /> O CONSTRUCTION ❑WOOD <br /> L 1f `y <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE >4 <br /> �d l <br /> GENERATING FACILITY (fr _ JV <br /> TRANSPORTE NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> -� <br /> CITY, STATE,ZIP <br /> PHO14i END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE 0F,4UTJq0FPZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑z L"y <br /> ❑ <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 /> EMARKS O SOIL <br /> ❑ CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> SIGNATURE OFAUTROMMD AGENT DATE ASBESTOS <br /> ❑WOOD <br /> AASH <br /> O SPECIAL OTHER <br /> SCHEDULING MUST BE—MADE PRIORTO 3 tm P M THE DAY PRIORTO 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 /> MANIFEST# <br /> W 30 <br /> r,r-NFRATOR COPY <br />