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Ll Keller canyon LJ ux Mountain U Ivewoy Islana rorwara <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 /> � mr... 2 ltl+lll�+ V A7.f t%. L'1Wi1ll. <br /> )411AILING ADDRESS <br /> A )t /I-- <br /> 77 Beiiile Street MA Code B24A <br /> YJ 1 t <br /> ;ITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Francisco, CA 94105 Q GLOVES O GOGGLES O RESPIRATOR Q HARD HAT <br /> 'PHONE <br /> i4l- 973-3-7- Q TY-VEK O OTHER <br /> CONT CT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> Robe-it GTay <br /> IGNATURE OF AUTHORIZED GENT/TITLE DATE 0 N <br /> GENERATOR'S CERTIFICATION:I hereby certify thAtdabove 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 /> a described,classified and packaged,and is in proper condition for transportation a-cording to applicable. <br /> "tions;AND,If the waste Is a treatment residue of'a previously restrkted hezerdous rests <br /> to the Land Disposal Flestndtons;l certify and warrant that the waste has been treated in'- RECEIVING..FACILITY <br /> eccprdanc.with the requirements of 40 CFR Pail 268 and is no longer a hazardous waste as defined by <br /> <O CFR Part 261 <br /> V1fASTE TYPE: <br /> ISPOSAL O SLUDGE <br /> L7 CONSTRUCTION Q WOOD <br /> OOTHER <br /> PfIg4L WASTE <br /> EERAT1G FACILITY <br /> Oy <br /> 'VEHI LICENSE NUMBER TRUCK NUMBER` <br /> 'Trans orfation <br /> CITY STATE;ZIP' �ll�• ,.� <br /> 4 <br /> PHONE' END D MP BOTTOM DUMP TRANSFER <br /> IGNA-rU[RgPFAUTH0RIZEgR DRIVER DATE ROLGOFF(S), FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> _l hereby certify that the above named material has been <br /> t_�.-accepted and to the best of my knowledge the foregoing <br /> IS true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL). <br /> DISPOSE OTHER <br /> U SOIL <br /> EMARKS <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> Q WOOD <br /> U ASH <br /> Q SPECIAL OTHER <br /> MEOW <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 PATHE 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 MANIFEST# 9 1846 <br />