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J Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward f <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill It <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road coot <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-'-(925)458-9891 Fax (650)726-9183 Fax(408)262-2871 Fax(209)982-1009 j <br /> NON-HAZARDOUS WASTE MANIFEST <br /> :NERATOR WASTE ACCEPTANCE NO. ] <br /> -1 01. ifaA CX. l_ai.VliU.AC <br /> ULING ADDRESS <br /> A"A0— <br /> 77 Beale Street <br /> rY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Fran e.i.gr a C.A ()4'1?0 ❑GLOVES ❑GOGGLES ❑RESPIRATOR L)HARD HAT � <br /> ]ONE 8 tI C <br /> -- I]TY-VEK ❑OTHER Ills 8 <br /> )N C ffF O <br /> SPECIAL HANDLING PROCEDURES: <br /> 3NATURE OF AUTHORIZEP AGENT/TITLE DATE <br /> '� —T°tizeri Agw!for <br /> ! ific 13aa&Elccfric 1 <br /> ?`dOili <br /> FNERATOR'S CERTIFICATION:1 hereby certify that the above named material is not a hazardous <br /> este as defined by 40 CFR Part 261 or title 22 of the Calitomia code of regulations,has been property <br /> ascribed,classified and packaged,and is in proper condition for transportation a-cording to applicable -- <br /> gulations;AND,If the waste Is a treatment residue of a previously restricted hazardous waste <br /> abject to the Land Disposal Restrictions,I cerfity and warrant that the waste has been treated in RECEIVING FACILITY l <br /> cordance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> I CFR Part 261. <br /> \STE TYPE: p'I <br /> DISPOSAL O SLUDGE It I <br /> CONSTRUCTION ❑WOOD <br /> 0 DEBRIS ❑OTHER <br /> O SPECIAL WASTE <br /> :NERATING FACILITY i <br /> »>:n[on Duhydrdkn iliomion <br /> A,.,,0oRTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> lX,nrieste i ransportation - ' _J <br /> DRESS <br /> 970 ll)enl[A"te CT <br /> �. <br /> FY, STATE,ZIP 1 . <br /> Wind-gor, ( A z - <br /> !ONE END DUMP BOTTOM DUMP TRAIN ER !k( 'I <br /> LI (JIiN UR F <br /> (707)838-1407 <br /> THORIZE AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS I <br /> ❑ ❑ ❑ ❑ �. <br /> CUBIC YARDS 4� ~ <br /> - I <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 Q t€ e <br /> It011I <br /> O SOIL <br /> MARKS i <br /> ❑CONSTRUCTION <br /> -NLITY TICKET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> 'NATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> ❑ASH <br /> U SPECIAL OTHER <br /> WILING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT I toil <br /> ',FUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> �4 7 <br /> GENERATOR COPY MANIFEST# -4 4 1' I `4. <br />