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❑ Keller Canon ❑ Ox Mountain ❑ Newby Island R Forward <br /> Sanitary Landfill _ Sanitary Landfill Sanitary Landfill `r Landfill <br /> 901 Bailey Road r - 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pdtsbuigj CA 94565 Half MobrsBay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> PhondJ925)458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fpx`(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERTOR o -' WASTE ACCEPTANCE NO, <br /> MAILING ADDRESS _ d (5�' 7 <br /> f 5" / <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> C= r. C-"/-- C- 117 -7 L -GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> PHONE <br /> ❑TY VEK ❑OTHER <br /> CONTACT PERSON 3"C—,Fr <br /> f r f,,!j ov1�� - �� ` � SPECIAL HANDLING PROCEDURES _ <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> GENERATOR S CERTI ICAIFION I hereby certify that the above named material Is not a hazardous <br /> waste as defined by 40 CFR Part 281 or We 22 of the Celifomia code of regulations has been property <br /> deacdbed classified and packaged and is in proper condition for transpartalion a-carding to applicable <br /> regulations AND,if the waste Is a treatment residue of•prsvlou*r"trlcted h}mrdous waste <br /> subject to the Land Disposal Restrictions I certify and warrant that'the waste hes been treated In RECEIVING FACILITY Q/Z LtJ A fL.� <br /> accordance with the requirements of 40 CFR Pant 268 and Is no longer ahazardous waste as defined by — <br /> 46 CFA Part 281 <br /> WASTE TYPE E <br /> ❑DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑9THER <br /> ❑SPECIAL WASTE j eF! <br /> GENERATING FACILITY <br /> ..yy �' ^r7+' fi /yam e '-4V /) <br /> TRANSPORTE t NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> L,IAI\ba, --- <br /> ADDRESS <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSF R <br /> ZZ 4 <br /> ❑ ❑ <br /> SIGNATUBE OFAUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> r ❑ ❑ ❑ ❑ <br /> �r <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been i <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 /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> D NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> D WOOD <br /> Q ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 RAA THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCH4DULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> MANIFEST# 38193 <br /> GENERATOR COPY , L <br />