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❑ Keller Canyon H Ox Mountain ❑ Newby Island 4�Vorward <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 /> 1 acific U-25&Z 111V6ltiV <br /> MAILING ADDRESS <br /> nog A- <br /> 77:Beale Street X4aiil Code B24A <br /> ,NTY;STATE;ZIP, REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> r1F_1 i_ �cc (v A 94105 U GLOVES U GOGGLES U RESPIRATOR U HARD HAT <br /> PHONE <br /> — U TY-VEK U OTHER <br /> ONT CT PERSON <br /> K> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT I TITLE DATE <br /> n <br /> J rjf�. ,_n�V T. ifqp <br /> :.GENERATOR'S CERTIFICATION:1 herebyfertly that the above named material is not a hazardous <br /> wastea*defined by 40 CFR Part 261 or titI422of the Califomia code of regulations,has been property <br /> •c described,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> regulations;AND,If the waste Is a treatment residue of a Previously restricted hazardous waste <br /> ~ Aubien to lhe;tand Disposal Restrictions,I certify and warrant mat the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is rid longer a hazardous waste as defined by <br /> :dOCFRPart,261. <br /> ASTE TYPE <br /> DI U SLUDGE <br /> U CONSTRUCTION U WOOD <br /> O DEBRIS U OTHER <br /> U.SPECIAL WASTE <br /> ,ENERAT(NG,FACILIT,iY� <br /> + f ids1. NOTES: "VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> DRESS. ' v <br /> Pq}P F <br /> ITY;STATE,ZIPWindsor, CA <br /> 9-54702-- <br /> HONE <br /> -- <br /> HONE END QQMP BOTTOM DUMP TRANSFER <br /> ee � ❑ ❑ <br /> �Y <br /> IGNATURE OFAUTHORIZED AGENT OR DRIVER DATE ROL - (S) FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> x <br /> 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 /> U SOIL <br /> EMARKS U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> SCHEDULING 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 /> GENERATOR COPY MANIFEST# 2 q+1 R?q <br />