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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island <br /> El 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 94019Milpitas,CA 95035 Manteca,CA 95336 <br /> it 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 /> Tacifi taw cVz Eh!O i <br /> MAILING ADDRESS <br /> 7 BeWa S-treet mail Stov B.24A 4314 <br /> CITY, STATE,ZIP' REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE Erre s ca C d1 0 0 GLOVES 0 GOGGLES 0 RESPIRATOR 0 HARD HAT <br /> x'. <br /> (4 5)9,,3-3773 O TY-VEK O OTHER <br /> CONTACTFERSON <br /> FLA,erE SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OFAUTHORIZED AGENT/TITLE DATE �x j <br /> f1 1 <br /> GENERATOR'S CERTIFICATION:I hereby cordy-that the above named materiaf 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 w-cording to applicable <br /> regulations;AND,if the waste is a treatment residue of a previously restricted hazardous waste <br /> ' subject to the Land Disposal Restrictions,f certify and warrant that the waste has been treated in - - <br /> accordance with the requirements of 40 CFR Part 268 and RECEIVING FACILITY is no longer a hazardous waste as defined by. - <br /> "40 CFR.Part 261_ <br /> WASTE TYPE: _ <br /> O U SLUDGE <br /> LI CONSTRUCTION A WOOD <br /> O DEBRIS U OTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY <br /> T{X3Deli <br /> RAl`IS� TER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY,STATE,ZIP <br /> Win&>r CA 95492 <br /> PHONE _ END DUMP BOTTOM DUMP TRANSFER . <br /> 7071 ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> 7­1 L11 Q L11 <br /> CUBIC YARDS <br /> I 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 /> REMARKS O SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> 0 ASH <br /> O 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 111 0 n n r%n 4 <br />