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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(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 <br /> WASTE ACCEPTANCE NO. <br /> x� •a: rte.,.. v. �>I, �..:,, <br /> �-a�suC.ilai:f tx. /11:41114 <br /> MAILING ADDRESS <br /> 77 Beale Street -Mail Coide 1324A 4J l`t <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Franrisco, Cly 94105 ❑GLOVES LI GOGGLES O RESPIRATOR O HARD HAT <br /> PHONE <br /> i_" LI TY-VEK ❑OTHER <br /> CONT CT PERSON <br /> f (;bert Cyray SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE/7 DTE <br /> 10� <br /> GENERATOR'S CERTIFICATION:1 hereby certify that 1W above named material isnot a hazardous <br /> waste as defined by 40 CFR Part 261 or tifle 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 /> regulations;AND,If the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in:- I 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 /> W STE.TYPE: <br /> �SbISPOSAL O SLUDGE <br /> 0 CONSTRUCTION ❑WOOD <br /> O DEBRIS- O OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> :1 A ttxt3at <br /> ° <br /> TES. VEH BER TR UCK;NUMBER <br /> �ett� te T x�ns matron. <br /> ADDRESS ' <br /> - <br /> CITY STATE,ZIP <br /> dsor, CA 95492 <br /> PHONE END UMP BOTTOM DUMP TRANSFER <br /> X01) o=t,r Q,7 Ul ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE RO - F(S) FLAT-BED VAN DRUMS <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 DffOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> 5 <br /> DISPOSE OTHER <br /> REMARKS O OIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> O WOOD <br /> O ASH <br /> ❑SPECIAL OTHER <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 /> GENERATOR COPY MANIFEST# 901 Q 0 n <br />