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] Keller Canyon F1 Ox Mountain El Newby Island I <br /> Sanitary"Landfill Sanitary Landfill Sanitary Landfill Landfill Illflfl <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road 11001 <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 i <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> i <br /> :NERATOR <br /> n--:4Z- r, 9. WASTE ACCEPTANCE NO. <br /> .l AVIL.V V Q.l it7l. 1�1.V V W.LV <br /> 11LING ADDRESS A!'fnn <br /> 77 Beaale Rtre nt •t 7 v 7 <br /> rY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Fraiurism, A 9417.0 P GLOVES 0•GOGGLES ❑RESPIRATOR Jf HARD HAT <br /> IONE <br /> ❑TY-VEK 0 OTHER <br /> )N O <br /> 73 <br /> SPECIAL HANDLING PROCEDURES: <br /> I <br /> 3N OFAUTHORIZFD AGENT/TITLE DATE <br /> A Agat for <br /> Pao filz Gm&Ekctt-jc <br /> irtiu� <br /> ENERATOR'S CERTIFICATION:1 hereby certify that the above named material is not a hazardous <br /> isle as defined by 40 CFR Part 261 or title 22 of the California 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 certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> I CFR Part 26 l <br /> cordance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> \STE TYPE: <br /> DISPOSAL ❑SLUDGE I <br /> O ONSTRUCTION O WOOD <br /> ❑DEBRIS ❑OTHER I <br /> O SPECIAL WASTE <br /> :NERATING FACILITYAftj <br /> y <br /> tniuM Iiiyirawr. iirxvrnitm <br /> AW-wORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> L"Elieste Trans rtation <br /> DRESS > ) <br /> :'870 DenBttRte Ct- <br /> rl(,STATE,ZIP <br /> CA 954Sk2 <br /> (Ii <br /> ON END DUMP BOTTOM DUMP TRAN FER I tllllf€t <br /> ❑ ❑ -i <br /> iN A RIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> CUBIC-YARDS <br /> ` i j <br /> I hereby c ify that the above named material has been i <br /> accepted abj to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER I&06,1 <br /> MARKS <br /> ❑ SOIL { <br /> ❑CONSTRUCTION <br /> ,ILITY TICKET NUMBER DEBRIS �. <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> iNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> I <br /> ❑ASH f <br /> i <br /> O SPECIAL OTHER <br /> IUUNG MUST BE MADE PRIOR TO 3:00 RM.THE DAY 001ORTO EXPECTED ARRIVAL*ANY UNSCHEDULED LOADS ARE SUBJECT 14 7 <br /> FUSAL UPON ARRIVAL. ONGOING DAILY DELIVONES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. I r l <br /> GENERATOR COPY MANIFEST# 342011 � .} <br />