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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 Halt 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 ai,1C i WASTE ACCEPTANCE NO. <br /> t � -ins "k- a,iCCuaC <br /> MAILING ADDRESS Al I A--- <br /> 77 <br /> 77 Beale Street Nfail Lode B24A YJ 1Y <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> a11t Francisco. CA 94105 <br /> O GLOVES D GOGGLES 0 RESPIRATOR Q HARD HAT <br /> PHONE' <br /> (415 973-3773 Q TY-VEK Q OTHER <br /> CONTACT PERSON <br /> Grav SPECIAL HANDLING PROCEDURES: <br /> Ro <br /> SIGNATURE OF AUTH RIZED AGEN E WATE //,p Iv-e-- <br /> `7 <br /> GENERATOR'S CERTI �.`I hereby candy m <br /> t the above named material is not a hazardous <br /> waste as defined by 40 CFR Pal# 1.or title 22 of the California code of regulations,has been property <br /> described,classified and packag ai is krproper condition for transportation on a-cording b applicable <br /> regulations;AND,If ttrc waste.ts rI ttpatment residue of a previously restricted hazardous waste <br /> ?ut>jact b the Lend Disposal.Resfriclions,1 certify and warrant That the waste has been treated in RECEIVING FACILITY <br /> accordance witti the requirements of 40 CFR Pail268 and is no longer hazardous waste:es defined by <br /> 40 CFR Part - - - <br /> WASTE TYPE: <br /> ISPOSAL Q SLUDGE <br /> /U—CONSTRUCTION Q WOOD <br /> O DEBRIS O OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> ` :5 _ - (T ICLEUCENS B TRUCK NUMBER <br /> - �n <br /> ADDRESS- <br /> :' --s.c,Ct. <br /> `ITY,STATE,ZIP <br /> Windsor, CA 95492 <br /> . .ONEEND UMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> SIGNATURE 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 /> O SOIL <br /> EMARKS <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> Q WOOD <br /> Q ASH <br /> Q SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO 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# <br /> 291804 <br /> 9 1 Q 0 4{j/� <br /> v <br />