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LJ Keller canyon U ux mounialn L) NeWDy Islana A I-orwarcl <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill i 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 /> i <br /> ` NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> a sati.aatio Uaa cx:%iC�.ut�+ <br /> a' MAILING ADDRESS <br /> A2 i ,,L- <br /> 77 Beale <br /> _77,Beale Street Rail Cade 824A � ' t <br /> .,ITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Nan Frr_.SaC CA 94105 <br /> O GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> •rk <br /> PHONE <br /> a -1 O TY-VEK ❑OTHER <br /> CONT CT PERSON _ <br /> Robert QM SPECIAL HANDLING PROCEDURES: <br /> x <br /> SIGNATURE OF#UTHORIZEDT/TITLF_ DATE /V y <br /> `�� GENERATOR'S-CERTIFICATION.I 'eretiy certify that the above named material is not a hazardous <br /> r,l waste as defined by 40 CFR P:M 26t a title 72 of the California code of regulations,has been properly - <br /> :'described,classified and paUiaged,and is ar proper condition for transportation acording to applicable _ <br /> 'a regulations;AND,H the vests is a treatment residue o/s prevbusly restrkted hezerdoua waste <br /> subject to ttietand Disposal Restnctions,1 certify and warrant that the waste has been treated in - 'RECEIVING FACILITY <br /> 'z accordancewith the requirements of 40CF,R Pari 268 and is no longer a hazardous waste as defined by <br /> 40 CFHPart26t: - <br /> 2 )WASTE TYPE: <br /> ISPOSAL U SLUDGE. <br /> U CONST 0 WOOD <br /> D DEBRIS O OTHER <br /> U,SPECIAL WASTE <br /> GENERATING FACILITY <br /> L t o f it tt Station Lathrop <br /> NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ra�asno on <br /> ADDRESS ���� <br /> CITY,STATE,ZIP <br /> Windsor. CA 95492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 1jn,,7N,838-1407 ❑ ❑ <br /> SIGNATURE OF UTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> 'i ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> 4 ; <br /> 1 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 /> ?t 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 /> U WOOD <br /> U ASH <br /> U SPECIAL OTHER <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 MANIFEST# <br />