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' ❑ Keller Canyon El Ox Mountain ❑ Newby Island �Eorward <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,SCA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br />' Phone(925)458-9800 Phone (650) 726-1819 Phone X408)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 2325 <br /> 425 N�_w&M Dorado Ave- <br /> CITY, <br /> e.CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Sto�CA 95202 ❑GLOVES U GOGGLES 5"RESPIRATOR U HARD HAT <br />' PHONE % a <br /> (209)937-W74 D TY-VEK U OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES <br />' SIGNATURE OFAUTHORIZEDAGENT/TITLE DATE <br />' <br /> GENERATOR S CERT1i 1GATiQN E hereby that named materia!is not a hazardous <br /> waste as defined by 40 CFR Part 281 ar tape 22 0l ilia Galrfonva wile of regulations has been pn� <br /> described,classified and packaged and is in proper condition for transportation a-cording to applicable <br /> regulations AND,if the waste Is a treatment residue of a previously reetrtcted hazardous waste <br /> subject to the Land Dmposal Restrictions I eerufy and warmnt that the waste has been treated In <br />' accordance with the requirements of 40 CFR Part 268 and Is no longer a hazardous waste as defined by RECEIVING FACILITY <br /> 40 CFR Part 261 <br /> W 5 E TYPE <br /> DISPOSAL U SLUDGE <br />' 1PONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br />' 110 West Sonoma St. STQCKTE?N <br /> TRANSPORTER r <br /> NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> TbMP 00 Co, <br />' ADDRESS <br /> 351 Norah Eeckm=Rd. <br /> CITY, STATE,ZIP <br />' LodkCA95240 <br /> PHONE EN UMP BOTTOM DUMP TRANSFER <br /> 358-6175 ❑ _ El <br /> SIGNATUR S AUTHORIZED GENT OR DRIVER DATE ROLL F FLAT BED VAN DRUMS <br /> C( �� 4 ❑ ❑ ❑ ❑ <br /> fCUBIC 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 [r0 BE COMPLETED BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> I o SOIL <br /> REMARKS <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> S107N44TUREoF &_HQAIZEDGENT DATE <br /> ❑WOOD <br /> I77 <br /> U ASH <br /> '/1 he IAL OTHER <br /> SCHED NG MUST BE MADE PRIOR TO 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# y r,-7 7 A q <br />