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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island Q 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 /> 'Pwiffic Cy4&Ek-diric <br /> MAILING ADDRESS 43 <br /> I. 77 Beale S-tre4 easel Stop B24A <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Ffand .CA 94120 U GLOVES U GOGGLES U RESPIRATOR U HARD HAT <br /> PHONE : . <br /> (415'973-3',t3 U TY-VEK U OTHER <br /> CONTACT PERSON <br /> b SPECIAL HANDLING PROCEDURES: <br /> Robot Gra <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE fIj ON L'" <br /> 4))5164 <br /> 9GENERATOR'S CERTIFICATION:I.he certify that the above named material is not a hazardous <br /> ri waste as defined by d0 CFR i?atf41 or title 22 of the California code of regulations,has been property <br /> Vie_ described classified and packaged and is in proper condition for transportation a cording to applicable i <br /> leguladons;AND,If the waslis_Is4itreatment residue of a previously restricted hazardous waste n <br /> Subject to the Land Daposa4*S' coons;l certify and warrant that the waste has been treated in RECEII/ING FACILITY <br /> r BCCOfdance withfhe requirements of 40 CFR Part 288and is no longer a hazardous waste as defined by <br /> _40CFRParf261. - - <br /> <br /> ) DISPOSAL USLUDGE <br /> L CONSTRUCTION U WOOD ' <br /> s > s RIS ❑OTHER <br /> )=CIAL WASTE ' <br /> sAT(NG FACILiTY <br /> LA1tt3F <br /> `3 T <br /> `Q EHICLE LICENSE NEffER R CK`It1fjIV1BER'`'' <br /> ADDRESS :; <br /> _�Y.STATE;ZIP <br /> 6,C 77A <br /> od i�r 7 A 95492 : <br /> HONE END DUMP BOTTOM DUMP ,;,,TRANSFER <br /> f+ ❑ ❑ . <br /> 1GNATURE OF AUTHORIZEDAGENT OR DRIVER DATE ROLL-OFF(S) FLAT,-BED VAN DRUMS <br /> CUBIC YARDS <br /> 1 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 /> A. is true and accurate. <br /> DISPOSE OTHER <br /> ❑SOIL <br /> 'x. EMARKS <br /> "a. O CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER O 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 a 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# 2 8 <br /> 9­,b9 Lj <br />