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J. Keller Fanyon- ❑ Ox Mountain ❑ Newby Island Forward i. <br /> Samtaiy Landfill Sanitary Landfill Sanitary Landfill Landfill I gra + <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road 4ltl:rt1 <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 /> F^-1925)458-9891 Fax(650) 726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> :NEnATOR r WASTE ACCEPTANCE NO. <br /> a adfii; �]aa �1CVM <br /> ULING ADDRESS <br /> ,�r►nn— <br /> 77 Beale Street Mail Code 1124A -t7L7 <br /> fY STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Francisco, CA 94170 O GLOVES U GOGGLES U RESPIRATOR U HARD HAT � <br /> IONE G II I<1 <br /> QTY-VEK Ll OTHER I1 <br /> )NT CT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> 3NATURE OFAUTHORIZED AGENT/TITLE DATE <br /> A+>t l ized Agent for <br /> V rte c Gm&HlectHe r .� ............ <br /> ftTu13f <br /> ENERATOR'S CERTIFICATION:1 hereby Certify that the above named material is not a hazardous <br /> We as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properly <br /> rscribed,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> gulations;AND,N the waste Is a treatment residue of a previously restricted hazardous waste <br /> ibiecf to the Land Disposal Restrictions,1 certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> zordance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> 1 CFR Part 261. <br /> kS E TYPE: <br /> ISPOSAL O SLUDGE <br /> CI CONSTRUCTION O WOOD I - <br /> O DEBRIS U OTHER <br /> O SPECIAL WASTE <br /> :NERATING FACILITY <br /> n�`i* &4tur Thoma na n,10 <br /> IAS ORTER NOTES: VENICE,F LICENSE NUMBER TRUCK NUMBER <br /> IDREllSS�este <br /> 820 <br /> -- r ate _t_ <br /> TY,STATE,ZIP <br /> Windsor, CA 95492 <br /> I - <br /> b$ ,I <br /> IONE END DUMP BOTTOM DUMP TRANSF R 07 <br /> t7h7)WAR-11 AQ ❑ ❑ <br /> 3NRWr=OFAUTHORI AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> 1�\,4 li Ll Q Q <br /> CUBIC YARDS <br /> I <br /> he ey certify that the above named material has been <br /> acc ted and to the best of my knowledge the foregoing DISPOSAL METHOD: BE COMPLETED Y F <br /> is true and accurate. (To Co EDB LANDFILL) <br /> DISPOSE OTHER I t[ItI <br /> U SOIL <br /> :MARKS <br /> U CONSTRUCTION <br /> CILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> aNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> )ULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT i ilt 1 <br /> :FUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. I 11141 <br /> GENERATOR COPY MANIFEST N -141 9 R 5 <br />