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I Keller Canyon U Ux Mountain U Newby Island fig; Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999S.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-a 819 Phone•'(408)945-2800 Phone(209)982-4298 <br /> Fax(925)4589891 Fax(650)726-9183 Fax(408)262-2871Fax(209)982-1009 <br /> ` NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS A Z' i-- <br /> 7 Bege Street NW Coche B24A <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> am Fsaric.3.yc_,O C.-A-9-4105 0 GLOVES`, 0 GOGGLES 0 RESPIRATOR O HARD HAT <br /> PHONE <br /> . (415"911-3773 <br /> 0 TY-VEK -0 OTHER <br /> CONTACTPERSON: <br /> r SPECIAL HANDLING PROCEDURES: <br /> Robert C= <br /> SIGNATURE OFA THORI ED AGENT/TITLE DATE <br /> 6 VT <br /> GENERATOR'S CERTIFICATION:I hereb that the above named material is not a hazardous.. <br /> waste as defined by 40 CFR Part 267 or till of the Cal, <br /> code of regulations,has been property <br /> described,dassified and packaged,and is' proper condition for transportation a-cording to applicable - <br /> regulations;AND,If the waste Is a treatment residue of a prevloualy.restricted hazardous waste <br /> subject to the land Disposal Rest coons;I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance 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 /> ISPOSAL O SLUDGE <br /> O CONSTRUCTION O WOOD <br /> O DEBRIS O OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> La�)ti dr for S1 D11 Lsltt3lO�l <br /> TRANSPORTER NOTES: TVEHICLE LICENSE NUMBER TRUCK NUMBER <br /> este r���ru3�4.a$z«n <br /> ADDRESS - <br /> HYD flN]tL+ r <br /> YV ,1J VSil�val4M:'� <br /> CITY,STATE,ZIP <br /> Windsor. CA r <br /> 95492 <br /> PHONE END©UMP BOTTOM DUMP TRANSFER <br /> )219-1 7, ❑ ❑ <br /> IGNA7U OFAUTHO ZED AG IVER DATE ROL FF(S) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ <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 /> O SOIL <br /> REMARKS <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> i O WOOD <br /> r <br /> 0 ASH <br /> O SPECIAL OTHER <br /> t 4. LM <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 MANIFEBT# g Q 1 A 9 1 <br />