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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 1604 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 N0. <br /> —,. <br /> I aijiuN. vas ix, e.t+Ctaic <br /> MAILING ADDRESS A->4.�_ <br /> Beale Street PvUl Code B24A 'Y <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San_ rater r.s�trn: (-'.-A-- - S <br /> PHONE Q GLOVES 0 GOGGLES 0 RESPIRATOR D HARD HAT <br /> 44I J• 973-3773 ❑TY-VEK O OTHER <br /> NTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> Robert QTay <br /> SIGNATURE OF AUTHORIZED AG . TJTITLI5, DATE <br /> GENERATOR'S CERTIFICATION:I her by certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the 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 residue of a previously restricted hazardous waste <br /> subject to the 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.CFR Part 261. <br /> VITASTE TYPE: <br /> DISPOSAL Q SLUDGE <br /> Q'CONSTRUCTION O WOOD <br /> O.DEBRIS O OTHER <br /> :OSPE-1AL WASTE <br /> ENE_RA ING FACILITY <br /> p Dehydrator Stafio 1 i-a1hrop <br /> RTER .,y.. p �, NOTES. VEHICLE LICENSE NUWER TR Lt 1 1"WER' <br /> es eI ransn tan <br /> DDRESS G-cfl l!>> r moi' ' <br /> ars r+a a a <br /> - uic,v-.w vau..r w.aw tea. <br /> STATE,ZIP <br /> Windsor, CA 95492 <br /> HONE END QUJAP BOTTOM DUMP TRANSFER <br /> r-r �8- nn7 ❑ ❑ <br /> SIGNATURE OF AU RIZEDAGENTORDRIVER DATE ROLLOFF(S) FLATBED 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 Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O 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 PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADSARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> r ��I�nnTnf�r,nov MANIFEST# n n A -7 f%7 <br />