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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island [9-15orward <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 -918 -2871Fax(925)458 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> a� v v£z$ lice iC <br /> AILING ADDRESS J <br /> r., Beale S. reef MailCode B24A <br /> It <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ap . rar_.xec•q� UA-- - <br /> Q GLOVES Q GOGGLES Q RESPIRATOR O HARD HAT <br /> PHONE <br /> !J` 973-3773 Q TY-VEK Q OTHER <br /> CONTACT PERSON <br /> Robert Grav SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUT RIZE AGE /jjTLE DATE <br /> t <br /> ,74 <br /> GENERATOR'S CERTIFICATION.I her ity.that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or'a 22 of ttie 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 treatment raaldue of a previously restricted hazardous waste <br /> Subject to the]and Disposal Restrictions,I certify and warrant that the wasteiias.been treated in RECEIVING FACILITY <br /> W. <br /> accordance with the requirements of 40 CFR Part 268 and is no lono a'liazardous waste as defined by <br /> 40CFR Part261: - <br /> WASTE TYPE: <br /> ISPOSAL U SLUDGE <br /> U C ,NSTRUCTION U WOOD <br /> O Q IS O OTHER <br /> fAL,WASTE <br /> "TACIL.ITY <br /> F-:itatl I p <br /> NOTES: VEHICLE'LICENSE NUMBERTRUCK NUMBER <br /> Y : em IT ortallort <br /> ITY iSTATE;ZIP 0 r 2" <br /> Windsor. CA 95492 <br /> is PHONE - - END QuyP BOTTOM DUMP TRANSFER <br /> s �r1Q38, 441" L) ❑ <br /> r 0 +,.,., �Y"t <br /> IGNATURE OF AUTHORIZED AGENT OR DRIVER DATE RO O F(S) FLAT-BED VAN DRUMS <br /> -- ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> I 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 <br /> EMARKS SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> U WOOD <br /> Q ASH <br /> Q SPECIAL OTHER Elmo <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a 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 /> 291802 <br />