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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill //q' Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsburg,CA 94565 Halt 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 /> F paCtuC vas c��i. 01cetnc <br /> ' jAAILING ADDRESS <br /> 77 Beale Street Maas Code B24A <br /> TY STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 7, Salt FranrlSCo CA 94105 Q GLOVES U GOGGLES Q RESPIRATOR U HARD HAT <br /> PHONE <br /> - ' 13_3771 Q TY-VEK Q OTHER <br /> FONT CTPERSON <br /> �, SPECIAL HANDLING PROCEDURES: <br /> Robertray <br /> SIGNATURE OF ALTTHORIZ D AGENT/TITLE DATE <br /> u6bd <br /> aENEHATOFYS CERTIFICATION:I hereby iy that the above named material is not a hazardous <br /> 8ste es deflned by 40 CFR Part 261 or fitle 22 of the California code of regulations,has been property <br /> , ,'cra3silred and packaged,and is in proper condition for transportation,a-cording to applicable <br /> ,(agnrahonS ANO;11 the waste Is a treatment residue of a previously restricted hazardous waste <br /> subjedtotheLandNsposalRestrictions,Icertify and warrant that the waste hasbeen treated in RECEIVING FACILITY <br /> dacordance with the requirements of 40 CFR Part 268 and is no longer a hazardous.waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> DISPOSAL L)SLUDGE <br /> Q CONSTRUCTION O WOOD <br /> U.DEBRIS U OTHER <br /> u_ 40ECIAL WASTE <br /> GENERATING FACILITY <br /> r ste5 T Iii l�Il 11,4 11� <br /> NOTES: VEHICLE LICENSE E TR;GWf77ATER <br /> DDRESS <br /> �2n Le�r3�tP,fit <br /> CITY,STATE,ZIPS <br /> Winchior. <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> s.-r M1y +n. ❑ ❑ <br /> SIGNA UR OF AUTHORIZED AGENT OR DRIVER DATE ROL OFFS) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> i 1410 4t <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 /> U SOIL <br /> EMARKS <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> L1 wooD <br /> r <br /> U ASH <br /> U SPECIAL OTHER <br /> • SCHEDULING MUST BE MADE PRIOR TO 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 /> GFNFRATOR COPY MANIFEST# q q 1 Q ir)q <br />