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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)94572800 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 /> P, Gl is Cas E cc c <br /> MAILING ADDRESS <br /> 77 Beale Street Mail Code B24A <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> S` 'r7P]C18rU' CA 94105 PHONE 0 GLOVES O GOGGLES 0 RESPIRATOR 0 HARD HAT <br /> 4 j j 973-3773 0 TY-VEK 0 OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> �r�bert Gran <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> ;y -'GEN'Ilk <br /> ERATOR'S CERTIFICATION;'t iheffN.cwtity that the above named material is not ahazardous' <br /> waste as defined by 40 CFR Pari 261 or'Me 22 of the California code of regulations,has been property <br /> descrbed,classified and packaged;and is in proper condition for transportation acording-to applicable <br /> regulations;AND,If the waste Is a treatment residue of.a previousty restricted hezardd4 waste . <br /> suf�ject to the lard Disposal Restrictions;4 certify and warrant that the waste has been Treated In` <br /> accordance withthe requirements of 40 CFR Part 268 and is no longer a hazardous waste'as defined by RECEIVING FACILITY <br /> .: 40 CFR Part 261. - <br /> WASTE TYPE: <br /> JDISPOSAL O SLUDGE <br /> CONSTRUCTION;_ O WOOD <br /> O DEBRIS O OTHER <br /> ,;; O SPECIAL WASTIE <br /> GENERATING FACILITY <br /> ..—z <br /> a, <br /> t <br /> �AAIV$RO '" <br /> NOTES. (CC L)C VSE NG AGER TRUE Nle.'., ER <br /> este a>tt rtatroxt �' <br /> <br /> CITY;STATE,ZIP , )eJ aeo-6k <br /> Windsor. CA 95492 <br /> ;PHONE END DUMP BOTTOM DUMP TRANSFER <br /> /707)838=14,A7 ❑ ❑ ❑ <br /> SIGNATURE OFAUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> tt <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 /> REMARKS SOIL <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> 0 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# ?q l Al A <br />