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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward <br /> Sanitary Landfill. Sanitary Landfill Sanitary Landfill XLandfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg,CA 94,565 ' 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 /> act& <br /> MAILING ADDRESS <br /> 77 Beak Street Mad Code.B24 A <br /> YJiY <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Smi Fr-.— Disc_�y CA 94105'PHONE 0 GLOVES O GOGGLES D RESPIRATOR 0 HARD HAT <br /> Q TY-VEK Q OTHER <br /> CONT CT ERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE a��ti t' <br /> GENERATOR's CERTIFICATION:,hereby certify 1 above named material is riot a hazardous <br /> waste as defined by 40 CFR Part 26P or title 22 0l alifomin code d regulations,has been property <br /> desa bed,lass f ed and packaged,and is in proper condition for transportation a-cording to applicable <br /> regulations;AND,It the waste Is a 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 /> acCordanee wilh tha requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR.'Part 261.1 <br /> WASTE TYPE: <br /> t 5 DISPOSAL U SLUDGE <br /> ❑:CONSTRUCTION O WOOD <br /> • 0 DEBRIS Q OTHER <br /> . Q SPECIAL WASTE <br /> GENERATING FACILITY <br /> e, este'r r= rtation <br /> <br /> st: CL <br /> CITY,STATE,ZIP <br /> bVhidsarr, CA 95492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 239-1 40'7, ❑ ❑ <br /> t SIGN OF TH ZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> e ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> - 1 <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 /> U SOIL <br /> EMARKS <br /> 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 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# '� <br />