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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island B'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 /> ENERATOR WASTE ACCEPTANCE NO. <br /> AILING ADDRESS Y�i4 — <br /> Bee Stmt ?Ltatl Code 24�� <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> aux rank»,>> UA 9411 <br /> - <br /> Q GLOVES Q GOGGLES 0 RESPIRATOR O HARD HAT <br /> PHONE <br /> rk? 415973-3773 Q TY-VEK O OTHER <br /> r CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> k< <br /> Robert Gran <br /> SIGNATURE OF AUTHORIZED AGENTJ TITLE JDATE ItI.DP-1— <br /> li _ <br /> ' .a <br /> GENERATOR'S CERTIFICATION:I hereby ofrlity that the above named material is not a hazardous <br /> waste esdefined by 40 CFA Part 261 or title 22 of the California code of regulations,has been properly <br /> a described classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> . regulatataAND,If the waste Is a treatment residue of a previously restricted hazardous waste <br /> s i4ea`6-j'tand Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accord .With the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> X40 CFR Part 261. -. <br /> WASTE TYPE: <br /> )66ISQOSAL Q SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> Q DEBRIS Q OTHER <br /> O SPECIAL WASTE <br /> :GENERATING FACILITY <br /> 1 <br /> ltO1ri lifurQp <br /> .� 4 <br /> 14T On : <br /> DRESS;." t <br /> CITY;STATE,ZIP �^6!9 <br /> Wiztdsor. CA 95492 <br /> HONE END DUMP BOTTOM DUMP TRANSFER <br /> r <br /> (7117)838-1407 ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE RQLL OFF(S) FLAT-BED VAN DRUMS <br /> l ❑ ❑ ❑ ❑ <br /> f * j4J6 <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 /> Q SOIL <br /> EMARKS <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE f <br /> Q 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 /> GENERATOR COPY MANIFEST# 291798 <br />