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u Ketler canyon U tjx mountain Li NeWDy Islana I-OrwarCl <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 v <br /> ACCEPTANCE N0. <br /> t. i as te. as ti ��ai�ii►v <br /> sgY MAILING ADDRESS An; <br /> 77 Beale Street Mail Code B24A <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> qan Fratnv.icc:O CA 941105, <br /> Q GLOVES Q GOGGLES Q RESPIRATOR Q HARD HAT <br /> PHONE <br /> �— Q TY-VEK Q OTHER <br /> CONTACT PERSDAL <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNAT RE OF AUTHORIZE AGENT/TITLE DATE <br /> 1UGN c-- <br /> GENERATOR'S CERTIFICATION:1 Hereby Aify t the above named material is not a hazardous <br /> waste°iu defined by 40 CFR part 261 or title ' the California code of regulations,has been property <br /> Gassill andacka <br /> a p ged,and is in proper condition for transportation a-cording to applicable <br /> ,fegtlt�y AND,If the waste Is s treatment residue of a previously restricted hazardous waste <br /> y Land Disposal Restrictions,1 certify and warrant that the waste has been treated in <br /> ttithe requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by RECEIVING FACILITY <br /> 40 Efi Part 261. <br /> WASTE TYPE: <br /> ISPOSAL U SLUDGE <br /> a_ O CONSTRUCTION U WOOD <br /> O DEBRIS U OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> ( 0?DenydratOr t31t()Tk 1 1 Lei O� <br /> z.. ; <br /> PATER NOTES.` VEHICLE LICENSE NUMBER TRUCK N[1MBER` <br /> Ste'rrampoludoll <br /> ITY,STATE,ZIP <br /> Windsor- CA 954192 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> �A ❑ ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> u <br /> CUBIC YARDS <br /> 1 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 SOIL <br /> EMARKS <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O 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 PRIORT0 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# 7 g l R?7 <br />