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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island 'RForward <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 Haff.Moon Bay,CA 94019 Milpitas,-CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Phdne(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 /> MAILING ADDRESS t <br /> 77 Beale Street Mail Code B24A <br /> R ITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> .. ;.:... _wnFrancisco � 94105 <br /> ' �- 0 GLOVES D GOGGLES ❑RESP{BATOR ❑HARD HAT <br /> `PHONE <br /> 5)973-37 73 ❑TY-VEK O OTHER <br /> CONTACT 15ERSON <br /> Robert Gray SPECIAL HANDLING PROCEDURES: - <br /> SIGNATURE OF AUTHOR14M AGENT/TITLE DATE ,�lj�Aji!E <br /> t- <br /> x GENERATOR'S CERTIFICATIPW here ity that the above named material isnot a hazardous <br /> waste as defined by 40 CFR Aa11261 a ti e 22 of the California code of regulations,has been property <br /> described,classified and and is n proper condition for transportation'a-cording to applicable <br /> dT regulations;AND,If the w treatment residue of a previously restricted hazardous waste <br /> subject to the.Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements 6140 CFR Part 268 and is no longer a hazardous waste as defined by. <br /> 40 CFR Part 261- - <br /> WASTE TYPE; <br /> ADISPOSAL ❑SLUDGE <br /> C7 CONSTRUCTION ❑WOOD r <br /> 0 DEBRIS ❑OTHER <br /> SPECIAL WASTE <br /> �. <br /> ' GENERATINGAI� <br /> s , <br /> rA N R; a NOTES VE�ill✓,"E'LICENSE NUMBER TRUCK NUMBER <br /> oYl <br /> ADDRESS <br /> CITY STATE,ZIP t j y1 ( <br /> Wilndsor, CA 9,5492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (711 <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> XZ' r <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 /> O SOIL <br /> EMARKS <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> ❑WOOD <br /> 6 ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO 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 /> rFNFRATnR(-.nPY MANIFEST# / Q 1 0`.1A <br />