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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island r,'X Forward <br /> Sanitary Landfill Sanitary Landfill - Sanitary Landfill Landfill <br /> 901 Batley Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA}94565 Half Moon Bay,�A 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(926$458-9800 Phone(650) 726-1819 Phone(408)945-2800 Phone (209)982-4298 <br /> Fax( )458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENER TOR coy- 4- C WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS _ 6 C ,' <br /> DGJ C <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 7-' A- -577 &GLOVES U GOGGLES ❑RESPIRATOR Q HARD HAT <br /> PHONE <br /> Q TY-VEK ❑OTHER <br /> CONTACT PERSON �� d .�-x <br /> '� z'€37� SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AG ENT TITLE DATE wt r5L t, G� f II-K r A-) -� <br /> GENERATORS CERTIFICATION I hereby certify that the above named materiel Is not a hazardous <br /> waste as defined by 40 CFR Part 281 or titre 22 of the California code of reguiations has been properly <br /> described,clasatlied and packaged and is in proper Condition for transportation azoording to applicable <br /> m regulations,AND,If the waste Is a treatment residue of a previously restricted hazardous waste <br /> autr]ect to the Land Disposal Reatrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY d ,�V—j �} <br /> accordance with the requirements of 40 CFR Part 268 and Is no longer d haroUs waste as defined try <br /> 40 CFR Part 281 <br /> WASTE TYPE <br /> ❑DISPOSAL �3 SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE }c S 0 r iF <br /> GENERATING FACILITY C*s 5e -4 _ )c <br /> " �' � fl t4 ;�Y, �ex cif C- ' <br /> TRANSPORTER Af NOTES VEHICLE LICENSE NUMBER T UCK NUMBER <br /> ADDRESS <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> r <br /> SIGNATURPPFXT,HORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to the beat of my knowledge the foregoing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> Q SOIL <br /> REMARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑WOOD <br /> ❑ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 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# 3 8 13 3 <br /> GENLRATOR COPY <br />