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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island ;--Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill '� Landfill <br /> 90t Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Fdt'sburg;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 /> C� <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST T <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> `. .1 aciLnkt %-Sao rx i4l+f iltr <br /> MAILING ADDRESS <br /> d <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Sack Fra»OiKo CA 94105 Q GLOVES Q GOGGLES U RESPIRATOR O HARb HAr <br /> PHONE <br /> 771 Q TY-VEK Q OTHER <br /> CONTACT,PERSON SPECIAL HANDLING PROCEDURES: <br /> Rpbfft Gray <br /> SIGNATURE OF ALTTH RIZED AGENT/TITLR j QATE <br /> GENERATOR'S CERTIFICATION:I hereby certify&I the above named material is not a hazardous <br /> waste.as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property <br /> described,classified and packaged,and is in proper condition for transportation a-cording.to.applicable <br /> regulations;AND,If the waste Is a treatment residue of a prevlousty restricted It <br /> aznrdous waste <br /> asubject to the land Disposal Restrictions,I certify and warrant that the waste has been treatod in RECEIVING FACILITY <br /> w accordance with the requirements of 40 CFR Part 2613 and is no longer a hazardous waste as defined by - <br /> 40 CFR Part 261. <br /> WASTE TYPE: _--- -- <br /> r <br /> DISPOSAL U SLUDGE <br /> /L)CONSTRUCTION U WOOD <br /> U.DEBRIS U OTHER - r <br /> L1SPECIAL-WASTE — <br /> GENERATING FACILITY <br /> f_at sop i)Chy(ir.-tor StationI.athrop — <br /> (RANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER' <br /> I:bBeste,'Lray..uin-o rtation <br /> ADDRESS , <br /> CITY,STATE,ZIP - <br /> )f i <br />