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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island K'Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <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 /> Ph6rie;(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 /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> 4 as u>:.;vcss us �:t4►to-iC <br /> MAILING ADDRESS <br /> 77 Beale Streot Mail Cade f324A �J i <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 4` !San Franr_.rcr_.n Ca 94105 <br /> O GLOVES ❑GOGGLES U RESPIRATOR U HARD HAT <br /> PHONE. <br /> U TY-VEK U OTHER <br /> CONT CT• ERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> Robert Cmy <br /> SIGNATURE OF ALJTHQRIZED AGENT,4 TITLE JDATE ® f <br /> r x r <br /> �� y iS eel, <br /> GENERATOR'S CERTIFICAMN I hereby carfiy that the above named material is not a hazardous <br /> .waste as defined by 40.CFR Part 261 q,title.T2 of the CalitomiA code of regulations•has been property <br /> deseribed classified and packaged,andi!kq%proper condition for transportation a-cording to applicable <br /> regulatrons ANq.0 tlta�t Is s treitnent residue of a previously restricted hazardous waste' <br /> subject to the laiftl Dtspc>Saf 8estnchot ;I certity and warrant that the waste has been treated in RECEIVING FACILITY <br /> % "accordance with the iepuirements of 4h CFR Pan 268 and is no longer a hazardous.waste as defined by <br /> CFR Pad 261. <br /> i <br /> WASTE TYPE <br /> ` DISPOSAL U SLUDGE <br /> s U CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> O SPECIAL WASTE <br /> GENERA li ITY y: <br /> r, : 'mor Staton <br /> r � <br /> NOTES: 'VERrOLE`LICIE MBER -_TRUCK NUMBER <br /> atattt�n <br /> ADDRESS ! <br /> ITY,STATE,ZIP <br /> win CA 9M92 <br /> #S­HONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ LlSIGNA UR OF AUTHO IZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> �, ❑ ❑ ❑ ❑ <br /> M p <br /> a CUBIC YARDS <br /> hereby certify that the above named material has been <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 /> U SOIL <br /> EMARKS <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> U WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> SCHEDUUNGMUST BE MADE PRIORTO 3:00 P.M.THE DAY ORIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST# / q 9 R I S <br />