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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill f `Landfill <br /> 901 Batley Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> Pittsburg,CA 94565 Half 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 (925) 458-9891 Fax(650) 726-9183 Fax (408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR A?J _c3P 0 WA-1 WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS _ :5 L_/ -5 r- <br /> �La <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE —rCSG K M (2 GLOVES -VGOGGLES O RESPIRATOR i(HARD HAT <br /> — U TY-VEK U OTHER <br /> CONTACT PERSON <br /> 171 `�� �O AI SPECIAL HANDLING PROCEDURES <br /> 5 . AlellgKSIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> ' r tt <br /> GENERATOR S CERTIFICA'1710N I hereby curt ty that the above named materials not a hazardous <br /> waste as defined by 40 CFA Part 261 or hue 22 of the calitorma code of repo bons has been Property <br /> described classified and packaged and is rn proper condition for transportation a'cordwV to applrcatrte <br /> regulations AND If the waste to a treatment residue of a previously restricted hazardous waste <br /> subject to the land Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance wnh the requirements of 40 CFR Part 269 and ss no longer a hazardous waste as defined by <br /> 40 CFR Pan 261 <br /> WASTE TYPE <br /> ISPOSAL ❑SLUDGE <br /> CONSTRUCTION 0 WOOD <br /> U DEBRIS O OTHER <br /> 0 SPECIAL WASTE <br /> ERATING FACILITY <br /> AJ CA,/ 'Ty /'1"1-c07d2 r2DOL_ <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> T_I IL <br /> DDRESS <br /> ITY, STATE, ZIP <br /> HONE END DUMP BOTTOM DUMP TRANSFER <br /> 7 ❑ ❑ ❑ <br /> OF UTHORIZE ENT O DRIVER DAT ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> Y ❑ ❑ ❑ <br /> 007 <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 /> U SOIL <br /> aEMARKS <br /> U CONSTRUCTION <br /> DEBRIS <br /> AGILITY TICKET NUMBER <br /> QNON-FRIABLE <br /> ASBESTOS <br /> TURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> J U ASH <br /> ILO SPE=CIAL OTHER <br /> EDULING MUST BE MADE PRIOR TO 3 00 P M THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> rO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> t- c"l 0rt <br />