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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 9.4565 Half Moon Bay,CA 94019 Milpitas;CA 95035 Manteca,CA 95336 <br /> Phone(925)45&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 /> 64A104% �DRESS <br /> Mail Stop BABA 43 <br /> 14 <br /> CITY STATE;ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Sarih�,t~A94120 U GLOVES U GOGGLES O RESPIRATOR O HARD HAT <br /> PHQNE:_. <br /> :(415)M, -3773 U TY-VEK U OTHER <br /> CONTACT PERSON <br /> �Rv4xnt Gray SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED ENT/TITLE JDATE <br /> CA V <br /> ,"- -.GENERATOR'S CERTIFICATION;.I hereby t the above named material is not a hazardous _ <br /> waste-as defined by 40 CFR Part 261 or title 2r=the California code of regulations,has.been property <br /> d ..� classified artd packaged;and i6in condition tot transportation a-:cording to applicable <br /> regulatigt N4:lf the waata is a treatment res(due of a previously restricted hazardous waste <br /> ' Fsublecftooro Land RestricUoru,.Icertifyand warrant that the waste has been treated in RECEIVING FACILITY <br /> �(i4igfs of 40 CFR Pad 2W and is no longer a hazardous waste as defined by. <br /> IiVAS7E,1YPE. <br /> `TDAL U SLUDGE <br /> CjCa, FtUCTION O WOOD <br /> CT¢ v O OTHER <br /> R �.. <br /> GENS . L4tTY <br /> A_.71IROp <br /> NOTES:` VEHI [E LICE NS `N' E " TFIl1Cf(`NUMBER' ' <br /> " do - <br /> �•� ,CA9a��92 J <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> t <br /> / ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> rt 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 /> q O SOIL <br /> PEMARKS <br /> O CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> 5 <br /> `SCIiEDULING 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 /> GENERAi OR COPY MANIFEST# 2 Q q L3 tQ E <br />