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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island ] Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill ' Landfill I <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 I <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 /> 1 NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> I <br /> MAILING ADDRESS <br /> ti <br /> CITY, A Paii REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Fr=cisco, CA 94120 0 GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> PHONE I <br /> O TY-VEK ❑OTHER <br /> CON I <br /> SPECIAL HANDLING PROCEDURES: I <br /> SIGN#bhfbVMHORIZED AGENT/TITLE DATE <br /> i"'t •- �' �Ay�1icY�-ixet!�'�gent for 1 j <br /> f` V �� ✓/p��y�aa! /$Ele / /' ) LTJ II <br /> ...+� <br /> WT___ r <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous 1�lUllit: l <br /> waste as defined by 40 CFR Part 261 or fide 22 of the California code of regulations,has been properly 1 <br /> described,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> regulations;AND,H the waste Is a treatment residue of a previously restricted hazardous waste j <br /> subject to the land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY } <br /> accordance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> 40 CFA Part 261. <br /> WASTE TYPE: I <br /> DISPOSAL O SLUDGE i .I <br /> Q'ICONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER I <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY i <br /> Thumioll-66. drdivr iitrJmiun <br /> .NSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> Den ieste -I ransportation -- ( <br /> ADDRESS t <br /> R7(1 1lenneRte (fit I <br /> CITY,STATE,ZIP <br /> - <br /> PHON ' END DUMP BOTTOM DUMP TRANSF R f t <br /> ❑ ❑ <br /> SIGN RI D AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> hereby certify that the above named material has been 1 <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 /> I � <br /> REMARKS ❑SOIL <br /> ❑CONSTRUCTION <br /> FACILITY TICKET.NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ) <br /> SIGNATURE OF AUTHORIZED AGENT ASBESTOS <br /> DATE <br /> O WOOD <br /> ❑ASH <br /> ❑SPECIAL OTHER } <br /> I <br /> CM RULING MUST BE MADE PRIONTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRNAL•ANY UNSCHEDULED LOADS ARE SUBJECT t <br /> RiEFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST N 342005 <br />