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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island ,,�r 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 /> 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 /> i�awx�iC �aS sac.%iCiiitU <br /> MAILING ADDRESS <br /> 77 Beale Street M e 2 *_j I <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Francisco, CA 94105 0 GLOVES 0 GOGGLES 0 RESPIRATOR Q HARD HAT <br /> PHONE <br /> Q TY-VEK Q OTHER <br /> CONTACT 15ERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> obert Gray <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE JDATE <br /> GENERATOR'S CEkRlFicxnm.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 California code of regulations,has been properly - <br /> desFffbed classified and packaged,and is in proper condition for transportation a-cording to applicable - <br /> reguTeyons ANOt if the waste is a treatment residue of a previously restricted hazardous waste <br /> s4b)6ta:4,,N,w laK:Disposal(;astrictions,I certify and warrant that the waste has been Treated in <br /> ecctirdcatrthe requirements of 40 CFR Pad 268 and is no longer a hazardous waste as defined by RECEIVING FACILITY <br /> 40 CFR Par1261:, <br /> WASTE TYPE:' <br /> 3 DISPOSAL U SLUDGE ' <br /> U GO <br /> UNSTRUCTION< ❑WOOD <br /> D DEBRIS O OTHER <br /> U SPECIAL WASTE. <br /> ,GENERATING FACILITY <br /> 1Y4 At p , <br /> of NOTES F,:I_f 11 NSE NUMBER TRUCK NUMBER <br /> to <br /> ThAnsWrtaldon - <br /> ADDR1SS <br /> 82!.1I3e'tt�3 ste rlt <br /> CITY,STATE,ZIP <br /> Winckor- CA 95492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 12P ❑ ❑ <br /> SIGNA UR -OFAUT ORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> jj ❑ ❑ ❑ ❑ <br /> ISA <br /> 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 /> LI SOIL <br /> REMARKS <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O 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 MANIFET# 291842 <br />