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D 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 Half Moon Bay,CA 94019 Milpitas, CA 95035 Manteca,CA 95336 <br />' Phone(925)458-9800 Phone (6500)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 /> NOWHAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> city <br />' MAILING ADDRESS 2328 <br /> CITY,STATE,ZIP re. REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 9toddx,CA95202 ❑GLOVES a GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> PHONE <br /> ❑TY VEK ❑OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> IS>�tlis <br /> SIGNATURE OF AUTHORIZFD AGENT/TITLE DATE <br />' GE-NERATOP S CERTIFICATION I h eby o4i4ow lfee above named materlai rs no a hazardous <br /> waste as detlned by 40 CFR Part 261 or title 22 of the Caalomia code of regutadons has been properly <br /> described etassdied and packaged and Is in proper condition for transportation a-cerdng to appkable <br /> regulations,AND,k the waste is a treatment rasidus of a previously reswcted hazardous waste <br /> subject to the Land Disposal Restrictions I cerhty and warrant that the waste leas been treated in RECEIVING FACILITY <br />' accordanco wdh the requtraments of 40 CFR Part 268 and Is no longer a hazardous waste as defined by _ <br /> 40 CFR Part 261 <br /> WAST TYPE <br /> ISPOSAL ❑SLUDGE <br />' D ISONSTRUCTION Q WOOD <br /> ❑DEBRIS 0 OTHER <br /> Q SPECIAL WASTE <br /> GENERATING FACILITY <br />' 110 wed Sams St BTOCKTON <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ThDIrP ADDRESSOil Ca 40 <br /> �� �� 3 /tq <br />' 351 ZM�33 �a <br /> CITY,STATE,ZIP <br />' Lodz CA95240 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> Ll <br /> 3 S-6 75 <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> z 11414, <br />' CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoin <br /> Is true and accurate. g DISPOSAL METHOD (CO BE COMPLETED BY LANDFILL) <br />' <br /> DISPOSE OTHER <br /> REMARKSd 5011. <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMB DEBRIS <br />' Q NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE 0 F A UTHJ0 R G EKT DATE <br /> ❑WOOD <br />' l ' 0 O ASH <br /> O S CIAL OTHER <br />' SCHEDULING MUST BE MADE 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 /> .. _... �..�. <br /> MANIFEST# 1 9 7 7 q Cl <br />