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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 9.0,65 Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone (925)458-9500 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 /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR )e -r L,- x WASTE ACCEPTANCE NO. <br /> d -T.4,✓r c E7 4; D C.t J N <br /> MAILING ADDRESS <br /> CITY,S ATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> c:L"P QrGLOVES U GOGGLES ❑RESPIRATOR 0 HARD HAT <br /> PHONE <br /> ❑TY VEK ❑OTHER <br /> CONTACT PERSON r J✓ arm-vS Za 3 <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE � �� � � ! A r_ 0 <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> waste as defined by 4a GFR Part 261 or title 22 of the Caldomra code of regulations,has been properly <br /> described classified and packaged,and is in proper condllion for transportation arwrding to applicable <br /> regulations AND.It the waste Is a treatment residue of a previously restricted hazardous waste p <br /> subject to the Land disposal Restrictions I certify and warrent that the waste has been treated in RECEIVING FACILITY Q 1 P fz { <br /> accordance with the requirements of 40 CFR Part 268 and Is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ❑DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS LI OTHER <br /> ❑SPECIAL WASTE $ -<D/ L <br /> GENERATING FACILITY _ 4 e—a <br /> 11157' 6�e � <br /> TRANSPORTS NOTES VEHICLE LICENSE NUMBER TRUC NUMBER <br /> ADDRESS ` <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER, <br /> SIGNATURE OF/ THO IZED 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 best of my knowledge th foregoing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate <br /> DISPOSE OTHER <br /> WU <br /> L <br /> EMARKS <br /> STRUCTION <br /> FACILITY TICKET NUMBER RIS <br /> -FRIABLE <br /> ASBESTOS <br /> SIGNATURE OFA THOR E NT PATE <br /> ❑WOOD <br /> f <br /> /O,ASH <br /> l6 SPECIAL OTHER <br /> ING MUST BE MADE PRIORTO 3 00 P M THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> 4L UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFOF C- <br /> MANIFEST# A I q <br /> TRAINS,?ORTER COPY <br />