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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)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> r e 1 A5.i3.tL-�_)Ja c7t, i',1'.V ti i.L <br /> e <br /> MAILING ADDRESS A11 4 . .. <br /> 77 lieale , trect- L'OM Code e A <br /> CITY, STATE ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT/ <br /> - <br /> >:: O GLOVES Q GOGGLES O RESPIRATOR O H$ID Ha <br /> PHONE <br /> -413 1,3--1/f.i Q TY-VEK O OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> Robe_rt Grav <br /> SIGNATURE OF AU ORIZED AGENT/TITLE JDATE <br /> IVONe- <br /> GENERATOR'S CERTIFICATION:I hereWcertify that the above named material is not a hazardous - - <br /> waste as defined by 40 CFR Part 261 or fide 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 /> 'r•' - regulations;AND,if the waste Is s treatment residue of a previously restricted hazardous waste <br /> subject to.the land Disposal Restrictions,I certify and warrant that the wastehasbeen treated'm RECEIVING'FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFA Part 261. - <br /> )WASTE TYPE: <br /> r'- ISPOSAL. D SLUDGE <br /> ❑ <br /> f CONSTRUCTION ❑WOOD <br /> ?' u DEBRIS OTHER <br /> O.SPECIAL WASTE <br /> GENERATING FACILITY <br /> I <br /> L,amrop vehydrator Statxon L att'<rcrp <br /> } MSPQRTER NOTES: VEHICLE LICENSE NUMBER T ..MQUMBER <br /> Denoeste 1 paar t o . o7n <br /> ADDRESS <br /> CITY,STATE;ZIP <br /> Windsor, CA 95492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (707)8384411'7 <br /> ❑ a <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE RQLL-OFF(S) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> k*iv. <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. Y <br /> DISPOSE OTHER <br /> Q <br /> EMARKS SOIL <br /> O CONSTRUCTION ° <br /> FACILITY TICKET NUMBER DEBRIS <br /> 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> Q ASH <br /> U SPECIAL OTHER <br /> SCHEDUtINOMUST 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 B FORE. <br /> GENERATOR COPY MANIFEST# 2 91 7 9 E <br />