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❑ Keller Canyon ❑ Ox Mountain U 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 /> -9891 -9183 -2871Fax`(925)458 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GEN aT A WASTE ACCEPTANCE NO. <br /> 1 L14LLi4 V{1k9 tYC, ti1NVt111.. <br /> MAILING ADDRESS All i A <br /> c e �e 0 c, i r— <br /> ITY STATE,ZIP REQUIRED.PERSONAL PROTECTIVE EQUIPMENT <br /> U GLOVES U GOGGLES U RESPIRATOR U HARD HAT <br /> PHONE <br /> -415' 97-3-3773 UTY-VEK UOTHER <br /> CONTACT PERSON <br /> Robert bra <br /> SPECIAL HANDLING PROCEDURES: <br /> t <br /> SIGNATURE OF AUTHO IZED AGENT/TITLE DATE rJ 0 t <br /> T f <br /> <: GENERATOR'S CERTIFICATION:I here 4y that the above named material is not a hazardous <br /> waste as defined-by 40 CFR Part 267 a title 22 0l fhe California code of regulations,has been property <br /> A.is described classified and padcaged,and is in proper condition for transportation a-cording to applicable <br /> regulations AN[b I(thc waste Is a treatrrront residue of a prevlousty restricted hazardous waste, <br /> subject to the tang Disposa(Restrictions,`I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance wW66 requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined M <br /> 4p CFR,Part 261. <br /> TYPE: <br /> �AIJ18PCISAL O SLUDGE <br /> �. CONSTRUCTION ❑WOOD <br /> LI EBRIS 0 OTHER <br /> 0SPECIAL WASTE <br /> } GENERATING FACILITY <br /> . Sin l.atrxrvp <br /> SER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER` <br /> es r41)$pCe. 031 <br /> ADDRESS <br /> CITY,STATE,ZIP <br /> Windsor. CA 95492 <br /> PHONE END DUMP BOTTOM DUMP: TRANSFER <br /> 707 83$flIT ❑ ❑ ❑ <br /> SIGNATUREPf AUTHORIZED AGENT O DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> Ll <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 /> U SOIL <br /> REMARKS <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•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 7 <br /> /'- qn! A <br />