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] Keller Canyon ❑ Ox Mountain ❑ Newby Island ( Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill yrs <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road 1k 7&# <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 I <br /> Fax(925)458-9891 Fax(650) 726-9183 Fax(408)262-2871 Fax(209)982-1009 1 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> _NERATOR WASTE ACCEPTANCE NO. <br /> kILING ADDRESS I <br /> A ClAn— <br /> Codc Y 7 V 7 <br /> TY,STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENTNan 11 <br /> TONE <br /> ° 9A1? Q-GLOVES (SGOGGLES a-PESPIRATOR O HARD HAT <br /> ❑TY-VEK O OTHER I #001 <br /> )N O SPECIAL HANDLING PROCEDURES: i <br /> I <br /> 3N 'HORIZED AGENT/TITLE DATE <br /> Audwizcd Agetit for <br /> 1; c Gm&E1et tric �( �f ley. <br /> ENERATOR'S CERTIFICATION:I her certify that the above named material is not a hazardous lr Vtlt' <br /> este 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 /> i <br /> gulations;AND,If the waste is::a treatment residue of a previously restricted hazardous waste <br /> tilled to ft land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> xordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> CFR Part 261. .�.I <br /> 4ST TYPE: ' <br /> DISPOSALi1 <br /> O SLUDGE <br /> CONSTRUCTION ❑WOOD <br /> O DEBRIS O OTHER <br /> U SPECIAL WASTE <br /> NERATING FACILITY <br /> III�()II 1}ehy&'tt0I Th(mikm <br /> IAP.- JRTER NOTES: VE CLE LICENSE NUMBER TRUCK NUMBER <br /> 0cnkleste �l rans rtation v <br /> )DRESS f go <br /> TY,STATE,ZIP- <br /> ION END YUMP BOTTOM DUMP TRANSFER !:illi <br /> '301 A 1117 <br /> ❑ ❑ I } <br /> 3NATJAISID540THORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS { <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> iiccepted and to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. I <br /> DISPOSE OTHER ht1 al <br /> MARKS <br /> Ll <br /> ❑CONSTRUCTION f- <br /> CILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> 'NATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> 0 WOOD <br /> i . <br /> ❑ASH <br /> O SPECIAL OTHER <br /> MUNG MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT 1E h N I <br /> ,FUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. > #I <br /> GENERATOR COPY MANIFEST# 342013 �•. <br />