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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill r Landfill <br /> 90.1. 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 ��.,.,. WASTE ACCEPTANCE NO. <br /> �xX L KViLllr.VA.� UL 1.:iW1i11+ <br /> MAILING ADDRESS <br /> ?7 Beate Street Mail Code B24A r " <br /> CITY STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Fr misce CA 94105 ❑GLOVES O GOGGLES D RESPIRATOR O HARD HAT <br /> PHONE <br /> ❑TY-VEK ❑OTHER <br /> CONT CT" ERSON <br /> RobertSPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE f �I <br /> rrt, 1 `-A� <br /> .4 <br /> GENERATOR'S CERTIFICATION:I ce.f,that the above naned material 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 /> 4' .regulations;AND,If the waste Is a treatment residue of a previousty restricted hazardous waste - <br /> {f aulol to the Lard Drsposal;Aestrictior s,l certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance v{rth ft require of 40 CFR Part 268 and is no longer a hazardous waste as defined by - <br /> 40'CFR.Part 261. <br /> BASTE TYPE: <br /> 01SPOSAL L7 SLUDGE <br /> CONSTRUCTION O WOOD <br /> O DEB, ❑OTHER <br /> ' ali)X'Stat'I(3II <br /> NOTES: VEHICLE UCENSE NUMBER TRUCKNUMBER .' <br /> wspp oil <br /> CITY STAIZIP tJ c C I I n <br /> to VL1ffi: CA,95492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> r,70Z)838-1407 A3 ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <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 /> O SOIL <br /> REMARKS <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> 0 WOOD <br /> 0 ASH <br /> O 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,# ?r1 j R? , <br />