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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)458-989 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> t 5t x �,Uas w I%A eta% <br /> MAILING ADDRESS. ti <br /> 77 Beale tr et Mia Code B24A <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Lara_•r�c��.r,, ----- ---- <br /> 0 GLOVES ❑GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> PHONE' <br /> (415) 973-3773 ❑TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> Ricibert Gray SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OFAU -HORIZED N �/TTLE, I DATE �i� <br /> ip,=&Z-I L 2 <br /> �fiRT 1R'S dRTIFiCATI :l hereby cAify that the above named material is not a hazardous <br /> 6 A'.Sdefined by 40 CFR Part 261 or He 22 of the California code of regulations,has been properly <br /> a6s`Ceb6d,.dassified and packaged,and is in proper condition for transportation arcording to applicable <br /> t trlahon3'jXND,If"waste Is a treatment residue of a previously restricted hazardous waste <br /> tub ed"to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> Cadance with the requirements of 40 CFR Part 266 and is no longer a hazardous waste as defined by <br /> �0 CFR Part 261. <br /> HASTE TYPE: <br /> b1EOSAL ❑SLUDGE <br /> RUCTION ❑WOOD <br /> r0 D IS; ❑OTHER <br /> AN"WASTE <br /> as - <br /> °tNG FACILITY <br /> fi*2 i)ela �lY at�ir�taitfl> z i amt cep <br /> s ._.., NOTES. E ICLE LICENSE NUMBER TRUCK`NUMBER <br /> n <br /> 9DDR . <br /> far va.uv.,ew- <br /> CITY,;STATE,ZIP <br /> Wkdsor, CA 95492 <br /> PHONE END PUMP BOTTOM DUMP TRANSFER <br /> J 819-1 10111 <br /> SIGNATUR OF AUTHORIZED AGENT O DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> ' ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> hereby certify that the above named material has been <br /> F" accepted and to the best of my knowledge the foregoing <br /> DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> a. <br /> ❑SOIL <br /> EMARKS <br /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑WOOD <br /> ❑ASH <br /> ❑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# <br /> 291800 <br />