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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island �®,Forward <br /> SanitaryLandfillSanitary Landfill Sanitary Landfill landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> PittsbGrg,CA 94566 Half Mogn Bay, CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phpmii(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 /> NON-HAZARDOUS WASTE MANIFEST <br /> GENE ATOR 0 X '0 X WASTE ACCEPTANCE NO. <br /> O .:S416'1 Cg: �cc! <br /> MAILING ADDRESS ell <br /> / r <br /> 97- <br /> CITY,STATE,ZIP _ REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> rte) . A- Et-GLOVES U GOGGLES U RESPIRATOR ❑HARD HAT <br /> PHONE <br /> ❑TY-VEK U OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DAT rj�j j5-L CC) A-1 ,4/f I AIA77-TD i L-- <br /> GENERATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> waste as damned by 40 CFR Part 261 or 11119 22 of the California code of regulations,has been property <br /> described classified and packaged,and Is in proper condition for transportallon armording to applicable <br /> regulations AND,If the was is a treatment residue of a previously reshlotsd hemrdous waste <br /> subject to the Land Disposal Restrictions I oertiy and warrant drat the waste has bben treated in RECEIVING FAC!LI a/ <br /> accordance with the requlrernents of 40 CFR Part 288 and Is no krnger a hazardous waste as donned by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> •DISPOSAL e, ❑SLUDGE <br /> ❑CONSTRUCT U WOOD , <br /> U DEBRIS ❑OT ER <br /> ❑SPECIAL WANT E R L <br /> GENERATING FACILITY t7 0 <br /> t <br /> ORTER NO NOTES VEHICLE LICENSE NUMBER TRUCKNUMBER <br /> S, ATE,ZIP <br /> PHONEEND DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE QFAUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> . µ-/� _ ❑ ❑ <br /> .fir Tf r` , �All <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 /> REMARKS ❑SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH <br /> ❑SPECIAL OTHER <br /> L* ��� I <br /> SCHEDULING MUST BE MADE PRIORTO 3.00 P M THE DAY PRIOR TO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE D Y BEFORE <br /> MANIFEST# <br /> C'i=hI( RATnR C'nPV <br />