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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 WASTE ACCEPTANCE NO. <br /> 1 Atstl.ttr ,Jab UC. lii�:\+tJ.iV <br /> MAILING ADDRESS - <br /> 77 Beale Street XW Code B24A *� <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Smn CA 94105 D GLOVES D GOGGLES D RESPIRATOR D HARD HAT <br /> PHONE <br /> D TY-VEK D OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> ,obcrt Gray <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE �✓ 1�'/ <br /> "+ GENERATOR'S CERTIFICATION:I hereby that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the Calrfomia code of regulations,has been property <br /> described,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> •rogulations;_AND,Mahe waste Is a treatment residue of a.previously restricted hazardous waste <br /> - <br /> subjectto the land Disposal Restrictions,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 /> r <br /> 40 CFti Part 261- <br /> WASTE TYPE: <br /> DISPOSAL D SLUDGE <br /> CONSTRUCTION D WOOD <br /> Q DEBRIS O OTHER <br /> ;.U S_ IAL WASTE <br /> ENERATING FACILITY <br /> <br /> 4 .` I� 413r�41©r.Nt.aitVn. Lath'roY P. <br /> ANSTER NOTES: VEHICLE:LICENSE NUMBER TRUCK NUfIBER <br /> este Transportation <br /> ADDRESS <br /> (,y ceftU <br /> CITY,STATE,ZIP <br /> %ndior. CA 95492 <br /> , <br /> PHONE EN DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> ` a'1GNfinPEYOF A THPWED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> G� <br /> CUBIC YARDS <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 /> �s. DISPOSE OTHER <br /> D <br /> REMARKS SOIL <br /> D CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> D NON-FRIABLE <br /> I <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> O WOOD <br /> D ASH <br /> D 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 /> rFt3FRATOR COPY MANIFEST# 9 Q 1 Q1 A <br />