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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 <br /> WASTE ACCEPTANCE NO. <br /> 1 CaV�J VGf,O SX. l:lAVL,L1V <br /> MAILING ADDRESS <br /> 77 BealeStreetMail Co& B24A •t J 1 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San firan6sr.o CA 94105 O GLOVES O GOGGLES O RESPIRATOR O HARD HAT <br /> PHONE <br /> - 971-17-71 O TY-VEK O OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHOR ED AGENT/TITLE DATE <br /> 4114I��- <br /> GENEf�ATOR'S CERTIFICATION:I her certify that the above nand material is not a hazardous <br /> waste as defiried by 40 CFR Part 261 or fide 22 of the California code of regulations,has been property <br /> a, <br /> --descnbed,classified and packaged,and is in proper condition for transportation a-cording to,applicable <br /> regulations;AND,It the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the.Land Disposal Restrictions,I certify and warrant that the waste has been treatedm RECEIVING FACILITY <br /> nc <br /> accordae with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CF i;Part 261. <br /> F t WA`a`TE TYPE: <br /> bispbSAL O SLUDGE <br /> O CONSTRUCTION O WOOD <br /> Q DEBRIS O OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACIEI,TY <br /> NOTES:` VEHICLE LICENSE*NUMBER TRO ,. ER' <br /> I�eslBesEe`Trans ria on _ <br /> <br /> �/ 3 <br /> ADDRESS <br /> i <br /> CITY,STATE,ZIP e v— <br /> 'Viinjsor, CA95492 <br /> PHONE END P BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> SIGNAWRE OF AUTHORIZED AGENT OR DRIVER DATE ROL -OF(S) FLAT-BED VAN DRUMS <br /> � Ir <br /> ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> 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 SOIL <br /> EMARKS <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 /> •SCHEDULING MUST 13E 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 /> r.PwF--RATnR c:nPY MANIFEST# 7 Q 1 01 n <br />