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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island Nf 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 94565 Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925)4587-9800 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 /> t.. [ay�iiit.VQA iX L1WL�+.V <br /> MAILING ADDRESS. <br /> k <br /> 77 ll i-'i— <br /> CITY STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> h San F»ncsr ty_A 94105 <br /> 05 <br /> PHONE 0 GLOVES O GOGGLES O RESPIRATOR 0 HARD HAT <br /> j , _ <br /> - 0 TY-VEK O OTHER <br /> CONT CT' ERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> Robert Gray <br /> SIGNATURE OF ALJTHORIZEPAGENT/TITLE DATE 1 <br /> 1 <br /> GENERATOR'S CER11F1CATION:i hereby t the above named material is rat a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 a California Code of regulations,has been property <br /> described,classified and packaged,and is in proper condition for transportation a-=ding to applicable <br /> regulations;AND.it the waste is a treatment residue of a previously restricted hazardous waste <br /> t subtext to the Land Disposal Restrictions,I cerfify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the regwrements of 40 CFR Part 268 and is no longer a Hazardous waste as defined by <br /> .40 CFR;�Pari 261_ .. .. .. <br /> WASTE TYPE: <br /> U'DISPOSAL O SLUDGE <br /> 'O CONSTRUCTION O WOOD <br /> 0 D��BRIS 0 OTHER <br /> U:SOCIAL WASTE <br /> GENERATING,FACILITY <br /> Uet�yartaian 1 oF. <br /> RAINS TER NOTES:; VEHICLE LICENSt44 1 'xER TRUCK' 7f111 <br /> 1)"este Transff !, <br /> ADDRESS } <br /> CITY,STATE,ZIPW soL CA 95492 <br /> PHONE: END DUMP BOTTOMDUMP TRANSFER' <br /> n _j A07 <br /> S1GNA FIR OF AUTHORIZED AGENT OR DRIVER DATE ROLL/-OFF(S) FLAT-BED VAN DRUMS . <br /> Ll <br /> ❑ ❑ <br /> r�- <br /> CUBIC YARDS <br /> A 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 /> 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> 0 ASH <br /> 0 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':# 2 g 1 R 9 F <br />