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] Keller Ca on ❑ Ox Mountain ❑ Newby Island Forward <br /> Sanitary Landfltt.: Sanitary Landfill Sanitary Landfill Landfill I#1Jlfl <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road i fE fi t! <br /> Pittsburg,CA 94565 Halt 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 j <br /> Fay(925)458-9891 Fax(650) 726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> ' I <br /> NON-HAZARDOUS WASTE MANIFEST <br /> fr t0." ElIc. c, <br /> :N "acT.' WASTE ACCEPTANCE NO. <br /> Vd., I <br /> AILING ADDRESS <br /> n ru�r►— <br /> 77 Beale Rl=cl Mail Code 1124A +�v <br /> lY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San FrariciscriCA 941?. U GLOVES O GOGGLES O RESPIRATOR ❑HARD HAT <br /> IONE <br /> U TY-VEK 0 OTHER i 1 iI< fd <br /> - - I <br /> )N SO i <br /> SPECIAL HANDLING PROCEDURES:ell criwr <br /> I <br /> 3NATUBf OF AIJTHOZED AGENT/TITLE DATE <br /> f arced Aged for <br /> ttc' t (iae&klecti, <br /> ENERATOR'S CERTIFICATION:I 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 California code of regulations,has been property <br /> mcribed,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> gulalions;AND,If the waste Is a treatment residue of a previously restricted hazardous waste <br /> ibjecl to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in <br /> � RECEIVING FACILITY <br /> ordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> I CFR Part 261. <br /> kS E TYPE: DOW <br /> DISPOSAL U SLUDGE i D <br /> NSTRUCTION O WOOD <br /> U DEBRIS ❑OTHER I j <br /> O SPECIAL WASTE <br /> :NERATING FACILITY <br /> anion Duhydtidt r l�l()Cai{(3A <br /> ANzr-ORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER i - • <br /> ntieste 'I ranmortation �(� <br /> DRESS (� <br /> rY,STATE,ZIP 1 <br /> 1A,5ndsor CA 9549) lbI <br /> ONE END DUMP BOTTOM DUMP TRANSFER 6141 <br /> ❑ ❑ ❑ �✓ <br /> IN EA RIZED AGENT ORD RIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> op <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been I - <br /> iccepted and to the best of my knowledge the foregoing <br /> is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> t <br /> DISPOSE OTHER <br /> fffe'�f <br /> MARKS O SOIL I `� <br /> U CONSTRUCTION f <br /> '.ILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> iNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> 1UUNG MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT so itlI <br /> FUSAL .d0bN ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST N " 4 2 0 0 9 <br />