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❑ Keller Canyon ❑ Ox Mountain ❑ Newby island 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 945651 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 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> t.u�.is.11:�ij ct,�j r,3C,S�;livt.Y tL <br /> MAILING ADDRESS A :)1 A— <br /> '17 e e Sheet XbR Co&B24A It-'sIt <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> a>nrancigC.n ('A-� - O GLOVES U GOGGLES U RESPIRATOR U HARD HAT <br /> PHONE <br /> U TY-VEK O OTHER <br /> CONTACT PERSON <br /> Robert CON SPECIAL HANDLING PROCEDURES`. <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE. �J/, <br /> GENERATOR's CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the Califomia code of regulations,has been properly <br /> f' described,classified and packaged,and is in proper condition for transportation a'cording to applicable <br /> l regulations;AND,If the waste Is a treatment residue of a previously restricted hazardous waste <br /> yl' subject to the Land Disposal Restrictions;I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with"requirements of 40 GFR Part 268'and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE: <br /> DISPOSAL U SLUDGE <br /> U CONSTRUCTION U WOOD <br /> U DEBRIS" O OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> Lathrop 1"A- 1i0ratorzitation Lwhr 11P <br /> V. <br /> t RAMS , 3.,-,,_,} NOTES`. VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> "PeTWeste ranSID0 Olt <br /> ! ADDRESS. �? ' <br /> CITY,STATE,ZIP <br /> Windsor CA 95492 <br /> PHONEFND DUMP BOTTQM DUMP TRANSFER <br /> 0 <br /> SIGNATURE OF.AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> L11 Q <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been <br /> accepted and td the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> ❑ <br /> EMARKS SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OFAUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO 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 MANIFE T# n n 4 n n n <br />