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Keller Canyon ❑ Ox Mountain ❑ Newby IslandForward <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,(925h 458=9800 Phone(650)726-1819 Phone'(408)945-2800 Phone(209)982-4298 <br /> Faie(J25&-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> hi -Jas & 'Ercculnc <br /> MAILING ADDRESS f <br /> 77 Beate Street NW Code B24A _17-3 A`t <br /> s <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Franr.il:rn {,"A1 0S 0 GLOVES 0 GOGGLES 0 RESPIRATOR O HARD HAT <br /> PHONE- <br /> " ' 1 11 0 TY-VEK 0 OTHER <br /> F- CONT CT ERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> Robert Gray <br /> Y SIGNATURE OFA THORIZE AGENT/TITLE DATE l /� <br /> \4 <br /> �1 � U E � � �� �' tom, <br /> s� <br /> GENERATOR'SCERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> a: waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property <br /> described classified and padcaged,and is in proper condition for transportation a-cording to applicable <br /> regulations,AND,N the waste Is a treatment residue of a previously restricted hazardous waste <br /> ,subject to the Land Disposal Restrictions„1 certify and warrant that the waste has been treated in <br /> '? .:accordance with the requirements of 40 CFR Part 268'and is no longer a hazardous waste as defined by RECEIVING`FACILITY - <br /> 40 CFR Part 2-6 <br /> W STE TYPE: <br /> DISPOSAL O SLUDGE <br /> 0 CONSTRUCTION O WOOD <br /> O DEBRIS O OTHER <br /> L11 SPECIAL WASTE <br /> ENERATING FACILITY <br /> wn Lathrop <br /> t RANSPORTER _ `` NOTES: 'vEHICLE`uCEN "E NUMBER: TRUCK NUMBER <br /> v • <br /> r ' este ramportat on /) <br /> (� <br /> t VI..V LV�V�4M S/1. <br /> PITY, STATE,ZIP 1 ; <br /> sWindsor, CA 95492 U <br /> PHONE END PUMP BOTTOM DUMP TRANSFER <br /> P11711)818-1 An ❑ ❑ <br /> SIGNA I IiV OF AUTHORIZED AGENT OR DRIVER DATE ROLL;O F(S) FLAT-BED VAN DRUMS <br /> Ll L11 LIr <br /> 7 <br /> .ii <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 <br /> EMARKS SOIL <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE r <br /> 0 WOOD <br /> O ASH <br /> 0 SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 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 /> GENERATOR COPY MANIFEST# 9 q 1 p g <br />