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❑ Keller Canyon H Ox Mountain Ll 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 /> � .; Rhone(925)458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> ,- <br /> Faz'(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> ' NON-HAZARDOUS WASTE MANIFEST <br /> FNERATOR WASTE ACCEPTANCE NO. <br /> " <br /> 1 L61r lk V A3 6%. liiL�l�td il <br /> 'r✓ MAILING.ADDRESS A'I <br /> ' 77 Beale Street NI"Cade B24A tJ 1 Y <br /> CIT! STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Fraa�ryann t'.A 9410s O GLOVES O GOGGLES O RESPIRATOR O HARD HAT <br /> ' PHOS_ <br /> 4 - 971-37 1 <br /> O TY-VEK O OTHER, <br /> CONT CT ERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> 'Robert GEay <br /> SIGNATURE OFA THORIZED AGENT/TITLE DATE <br /> 3..; F1�14W1,5#00, CERTIFICATION:I her eb that the above named material is not a hazardous <br /> : . tBst4�`' tied by 40 CFR Part 261 a ti 22 the Califomia code of regulations,has been property <br /> 4' rdassified and packaged,and is in p oper condition for transportation a cording to applicable <br /> ` "4 AN0.If the waste Ira treatment residue of a previously restricted hazardous waste <br /> aubledbrhe Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> erxOrtiapce with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> CFR.-Part 261. + <br /> WASTE TYPE: <br /> t ADISPOSAL O SLUDGE <br /> C1 CONSTRUCTION O WOOD <br /> D QEBRIS O OTHER <br /> EGIAL WASTE <br /> t �n <br /> E }ERATING FACILITY, <br /> _ NOTES: VEiiIC' ;.S si=R' TRUCK NUMBER <br /> fl,RTER, <br /> f `fir e� � I'�1SLS(3I'ki�>vliTIt <br /> DQRESS <br /> v <br /> <br /> Windsor, CA,95492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> SIGNA I IRE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) 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 DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> O <br /> EMARKS SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> O ASH <br /> O SPECIAL OTHER <br /> "S HEDULJNG MUST BE MADE PRIOR TO 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# <br /> 9Q1 Pi Q <br />