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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island �orward <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 WASTE ACCEPTANCE NO. <br /> AILING ADDRESS -{ <br /> Ivo e A _�t tr <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> - <br /> F O GLOVES 0 GOGGLES ❑RESPIRATOR O HARD HAT <br /> PHONE . <br /> -- Q TY-VEK O OTHER <br /> ., <br /> 4 CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> Robert Grav <br /> SIGNATURE OF AUTHORIZED AGENT/TITLEY DATE +Al-ICL <br /> c`c GENERATOfi'S'aR-nFICATION:I here certify that the abcke namedrdous <br /> uta ion <br /> waste,as defined by 40 CFR Part 261 or title 22 of the California code of r s,has been properly <br /> described,dassifiedand packaged,and is in proper condition for transP�i��a^pdrdirg to applicable <br /> regul@tiom,,AND,K the waste Is a treatment residue of s previousty ra tdcted hazardous waste <br /> subjea to ft Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance'with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFIfi'Pant261. <br /> WASTE TYPE: <br /> ? POSAL U SLUDGE <br /> Q ONSTRUCTION Q WOOD <br /> O.DEBRIS, O OTHER <br /> s O"SP_ECIAL WASTE <br /> GENERATING.FACILITY <br /> ��hy�iarator <br /> Station Liffimp <br /> x <br /> , <br /> SPORER <br /> NOTES: VEHICLE LICE:SE i�7-MBER TRUCK NUMBER <br /> ADDRESS <br /> _ p <br /> G}TY STATE,ZIP <br /> Wimdsor; CA 95492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (7707)838-1407 ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROL -OFF(S) FLAT-BED VAN DRUMS <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 /> YEMARKS O SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> Q ASH <br /> Q SPECIAL OTHER <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 /> r_F�+GaeTnp c npv <br /> MANIFEST-4 n rN A -7 n r% <br />