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-❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward <br /> Sanitary 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 Halt 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(9251458-8891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR - WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> /5'93 4 9-R�ory <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> E7 9 AI� ` '� ❑GLOVES 3 GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> PHONE <br /> U TY-VEK ❑OTHER <br /> CONTACT PERSON 3'357ij <br /> !.r/AeGlti' `A,,v� ,J � -5 'J !/!r-�i SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE f A.; 7,4111 ovA-7 � t� .�ey I L <br /> 4.1 <br /> GENERATOR'S CERTIFICATION 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 property <br /> described classified and packaged,and Is in proper condition for transportaffon aroording to applicable <br /> regulations AND,N the waste is ri traatmaaf ttly an a or a prwAouslnt that the rite has <br /> eenarea a weatr RECEIVING FACILITY <br /> subject to the Land Disposal Restrtctlona I certHy and warrant that the walla has bean treated in <br /> accordance with the requirements of 40 CFR Part 2613 and Is no Ionger a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ❑DISPOSAL ❑SLUDGE <br /> •CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY [" ( r yc <br /> 7-!7- A e-7 <br /> TRANSPORTER ^"" 1 NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <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 /> U SOIL <br /> REMARKS <br /> CI CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHOR ZFD AGENT DATE <br /> ©WOOD <br /> ❑ASH <br /> it� f�� ❑SPECIAL OTHER <br /> SCHEDULING MUST BE 4ADE 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# 38134 <br /> ('r-KJPRATr)R COPY <br />