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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 /> i <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> s a�,i tts. vwa dti �:lVi'iy tlr <br /> MAILING ADDRESS A:) <br /> e14- <br /> ,e treei ��aa Code BL4A -t-' <br /> 'CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Franc-ist c 4: (_.__94105 <br /> Q GLOVES O GOGGLES U RESPIRATOR Q HARD HAT <br /> PHONE <br /> (41 <br /> - 973-3773 Q TY-VEK Q OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> H Robert Q-av /41 <br /> SIGNATURE OF AUTHORI D AGENT/TITLE DATE <br /> f } <br /> 1 ( [�Aj( <br /> ' 1 <br /> GENERATOR'S CERTIFICATION:I herek celtity that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or tit of the California code of regulations,has been property <br /> N described,classified and packaged,and is in proper condil*n for transportation a cording to applicable <br /> 'regulations;AND,if the waste Is a treatment residue of a previously restricted hazardous waste <br /> a subject to 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 /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> ISPOSAL D SLUDGE <br /> U CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> AAa hydratorStation Lathrop <br /> NOTES: VEHICLE LICENSENUMBER TRUCK NUMBER <br /> rI ranspor on 00 <br /> ITY,STA,E,;ZIP A), IGL❑ <br /> Windsor, CA 95492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 70 838-1407 ❑ ❑ <br /> JIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROL -OFF(S) FLAT-BED VAN DRUMS <br /> i <br /> W: <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 /> U SOIL <br /> REMARKS <br /> U CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ;- ❑WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 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# n Al <br />