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] Keller Canyon w, 0 Ox Mountain ❑ Newby Island Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 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 <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 6 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> iNERATOR WASTE ACCEPTANCE NO. i Ix l <br /> ►ILING ADDRESS r <br /> �Ariv_7 <br /> �� REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> an <br /> IONE CA 94120 Franniqrc) ❑GLOVES ❑GOGGLES O RESPIRATOR LI HARD HAT <br /> ❑TY-VEK ❑OTHER <br /> )NT E i `'• <br /> SPECIAL HANDLING PROCEDURES: <br /> 3N HORIZED AGENT/TITLE DATE <br /> {f j -Ized g'tit for / <br /> l is CTUR he F1ech-ir //` { Vaal <br /> ftT <br /> ENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous S�Itt41� i <br /> tste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property <br /> scribed,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 /> bject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> cordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by l <br /> 1 CFR Part 261. - <br /> 1STE TYPE: ( ` <br /> ISPOSAL ❑SLUDGE I _ <br /> CONSTRUCTION O WOOD <br /> O DEBRIS ❑OTHER <br /> O SPECIAL WASTE <br /> :NERATING FACILITY <br /> - ounton i i>< ciraiur I nornkon <br /> AN-, JRTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> DRESS <br /> 0820 DiemBestc. Vit, i <br /> Y,STATE,ZIP <br /> W;adsor CA 95492 <br /> ONEEND DVMP BOTTOM DUMP TRANSFER <br /> iN E AO � RIZED AGENT OR DRIVER DATE, ROL - FF(S FLAT-BE❑D VAN DRUMS <br /> Ll <br /> CUBl$QY RDS RCsfa' <br /> hereby certify that the above named material has been <br /> Iccepted 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 /> 1AARKS 0 SOIL <br /> ❑CONSTRUCTION <br /> :ILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> NATURE OF AUTHORIZED AGENT DATE ASBESTOS .q l <br /> O WOOD l � <br /> O ASH i <br /> O SPECIAL OTHER <br /> t)LING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> FUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY.BEFORE. <br /> GENERATOR COPY MANIFEST M 3-42012 I �. <br />