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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island AForward <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(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 /> `►e. <br /> CITY, STATE,ZIP REOUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> MoCktoo,CA95202 0 GLOVES Q GOGGLES 0 RESPIRATOR 0 HARD HAT <br /> PHONE <br /> (209)937-8374 0 TY VEK 0 OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES <br /> I � <br /> SIGNATURE OFAUITHORIZFeD AGENT/TITLE DATE <br /> r <br /> 14/40 <br /> I c5r;w v7 F'3 Zr;;i Audi that the above named material is not a hazardous <br /> waste as defined by 40 CFF Part 261 or 09 22 of the Cal fomia code of regulations has been properly <br /> described classified and packaged and Is In proper condition for tnumportation a-cording to applicable <br /> regulations ANt> if the waste is a treatment reakhm*10 previously restrlcted hazardous waste <br /> subject to the Land Disposal Restrlcbons I cerbfy and warrant first the waste has been treated in RECEIVING FACILITY <br />' accordance with ft requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> DISPOSAL ❑SLUDGE <br /> CONSTRUCTION 0 WOOD <br /> U DEBRIS 0 OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> 110 wet st. 9T CKTON <br /> TRANSPORTER NOTES VEHICLE uCENSE NUMBER TRUCK NUMBER <br /> Th�01 Cat, <br /> ADDRESS <br /> 351 Nath Saddam Rd <br /> CITY,STATE,ZIP <br />' CA9524Q <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 209 368-6175 ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br />' ❑ ❑ ❑ ❑ <br /> ICUBIC 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 />' o SOIL <br /> EMARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> I Cf NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE ❑WOOD <br />' 0 ASH <br /> U SPECIAL 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 /> MANIFEST# i a 7 7'Z'Z <br />