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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 /> GENENATQBWASTE ACCEPTANCE NO. <br /> i auiuiC v`a� �:ixc;;�>C <br /> MAILING ADDRESS A:�1 A <br /> 77 <br /> ,e .e See a ra;�,— <br /> CITY'STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> U GLOVES O GOGGLES U RESPIRATOR U HARD HAT <br /> PHONEY <br /> (4i5)973-31 71 ❑TY VEK D OTHER <br /> `$ CONTACT PERSON <br /> Robert Gray SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AU HORIZED AGENT/TITLE DATE A/j1!Ve/ <br /> /ZED <br /> GENERATOR'S CERTIFICATION:1 hereby certify that the above <br /> m <br /> naed material is not a hazardous <br /> waste as defined by 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,cording to applicable <br /> regulations;AND,If the waste Is a treaonent residue of a previously restricted hazardous waste <br /> subject to the Land Drsposal Restrictions.I certify and warrant that the.wasle has been treated in <br /> accordance'with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by RECEIVING FACILITY <br /> 40 GFR Part 261. _ <br /> WASTE TYPE: <br /> J�ZISPOSAL O SLUDGE <br /> TION O WOOD <br /> O DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1_ tlllop deli *ato>r'station 1_aalrop <br /> r RA, f3 ER x NOTES: VEHICLE LICENSE WMBER TRUCK NUMBER <br /> . <br /> e esransoo taxi <br /> ADDRESS <br /> CITY, STATE,ZIP <br /> Windsor, CA 95492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> L) ❑ ❑ <br /> SIGNATUR OF AUTHORIZED AGENT OR.DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <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 /> 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 /> 0 <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# n n A n n r <br />