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' ❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island Orward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill andfill <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(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 WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS 2328 <br /> 42 5 Nam Ell vie. <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Stockitas,CAM02 U GLOVES U GOGGLES U RESPIRATOR 0 HARD HAT <br />' PHONE <br /> (209)PYr-BM ❑TY-VEK U OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br />' SIGNATURE OF AUTHORIZED AGENT/TffLE JDATE <br />' GF-NEFiATM S CERTIFICATION I hereby certify that the named materiel is not a hazardous <br /> waste as deflosd by 40 CFR Part 261 or ape 22 of dw C.a1lfCmta code of regulations,has been properly <br /> described classified and packaged and Is in proper common for transportation axording to aPpl'oable <br /> regulations AND,if the Waste is a heatmant residue of a PrwIQUslY roatrteted hazardous waste <br />' subject to the Land t hsposal Restrlellans I codify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirwnerft of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WA$TZ TYPE <br /> MST <br /> SAL USLUDGE <br /> RUCTION U WOOD <br /> 0 DEBRIS U OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br />' 110 Wed Sonoma SL STOCK TON <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br />' oil Qx g/ -z, l 4 7 3 l"i z�0 <br /> ADDRESS <br /> 351 Nbidh Bec>I WIM R& <br /> CITY,STATE,ZIP <br />' GA <br /> PHONE 95Z4D END DUMP BOTTOM DUMP TRANSFER <br /> J68-s175 <br /> SIGNATURE OF AUTHORIZED GENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> 0* 1Agrroz <br />' CUBIC YARDS <br /> 1 hereby certify that the above named material has been <br />' accepted and to the best of my knowledge the foregoing DISPOSAL METHOD (1.O BE COMPLETED BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br />' a SOIL <br /> EMARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br />' U NON-FRI LE <br /> ASBE S <br /> SIGNATURE OF AUTHORIZED AGENT DATE W <br /> U ASH, <br />' * U SPECIAL OTHER <br />' SCHEDULING MUST B E PRIORTO 3.00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> MANIFF4'r S -1 CZ 77 7 11 <br />