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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island 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)458-9800 Phone(65%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 /> �e}Y 1 A4.tJ1Rs VM7 17t, 1�LVLU.i1+ <br /> (LING ADDRESS 431 <br /> 14 <br /> 77`Beale Street Mail Coote B24A <br /> 1TY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ,'ark r :�cr9, C:r1 y_'105 <br /> ❑GLOVES U GOGGLES O RESPIRATOR Q HARD HAT <br /> PHONE <br /> Q TY-VEK Q OTHER <br /> a <br /> CONTACT PERSON <br /> { ; <br /> upbert QW SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> t GENERATOR'S CERTIFICATION:I h4by certify that the above named malarial is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property <br /> 'described,classified and.packaged,and is in proper condition for transportation a-cording to applicable <br /> r regutal orts;AND,ff the waste is a treatment residue of•previously restricted hazardous waste <br /> subject to'the Land Disposal Restrictions,I cerlity and warrant that the waste has bean treated in RECEIVING FACILITY <br /> egw <br /> $z Stgcordance w4h the rrements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261: <br /> A PE: <br /> DISPOSAL U SLUDGE <br /> PINSTRUCTION. U WOOD <br /> OlRERIS 0 OTHER <br /> + <br /> 'WASTE <br /> IG,FACILITY <br /> auffop <br /> g I�SPE� EIi " NOTES: VEH LE LICENSE NUMBER TRUCKNW15 <br /> L Tfambortation <br /> ADDRESS,. w <br /> CITY,' STATE;ZIP �❑'�� �l�,fY�� <br /> Windsor. CA 95492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> l7- 14 �l A()-7 L)r NATURE�OFAUTHORIZED AGENT OR DRIVER DATE ROL - FF(S) FLAT-BED VAN DRUMS <br /> CUBIC YARDS <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 /> 0 SOIL <br /> EMARKS <br /> Q 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 I - __ - <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 /> GFI`FRATOR COPY MANIFEST# �)q l Q 9 A <br />