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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.ALItA2L ♦.JaD 1JC. L:r1ltl+Li lib <br /> MAILING ADDRESS )1.4— <br /> Beale teeet P&A Code B24A <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> U GLOVES U GOGGLES 0 RESPIRATOR U HARD HAT <br /> PHONE * <br /> (415)973-3773 U TY-VEK U OTHER <br /> CO-Robmt SON <br /> Gray SPECIAL HANDLING PROCEDURES: <br /> g est' 1 <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE 1 <br /> GENERATOFl;S-,CERTIFICATION.I hereb certify that the above named material is not a hazardous <br /> waste as defined '40 CFR Part 261 or title 22 of the California code of regulations,has been property - - <br /> described,classified and packaged,and is in proper condition for transportation a-cordingto applicable - <br /> regu4t";AND;It"waste Is a treatment residue of a prevlousy restricted hazardous waste <br /> subfept to the land Disposal Restrictions,l certify and warrant that the waste has been treated in RECEIVING FACILITY" - - <br /> aoc"rrce with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by - <br /> 4l)GFR:Part 261' <br /> WASTE TYPE: <br /> DISPOSAL U SLUDGE <br /> U CONSTRUCTION U WOOD <br /> ❑DEBRIS U OTHER <br /> U`SPECIAL WASTE: <br /> i GENERATING FACILITY <br /> P <br /> 1 + 11Tt fl3 '�11 't3Stt5ff i1d«$t.0 1 csi 7�1{� <br /> r"FANSPORTER NOTES` VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ' txntjesteiranspo.rlau—on <br /> ADDRESS <br /> CITY,STATE,ZIP <br /> Windsor, CA 95492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 707)838-140'#7 ❑ ❑ <br /> SIGNATUP OF AUTH IZED A NT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> ❑ ❑ Lk L) <br /> -��X"t'.5. <br /> CUBIC YARDS <br /> hereby certify that,the above named.material has been <br /> accepted and to1he best of my knowledge the foregoing <br /> DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> U <br /> EMARKS SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRISU NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> •SCHEDULING MUST BE MADE PRIORTO 3o%&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# 1)Q I <br />