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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island [(Forward <br /> Sanitary Landfill iSa�ary Landfill Sanitary L�fill Landfill <br /> 901 Bailey Road ;123i�SaIn Mateo Road 1601 Dixon Lan ing Road 9999 S.Austin Road <br /> Pit?sburg,CA 94565 Half Mood 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(925V5C-9891 Fax(650)726-9183 Fax (408)262-2871 Fax (209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR rpt^ r 4 ! _!' i WASTE ACCEPTANCE N0, <br /> MAILING ADDRESS—]i a;7 q q J <br /> CITY, STATE,ZIP r _ c,' t 2 REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE S O GLOVES ❑GOGGLES O RESPIRATOR O HARD HAT <br /> ❑TY-VEK ❑OTHER <br /> CONTACT PERSON.),4i,,. ( \ <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTH .RIZED.AGENT/TITLE DATE <br /> f <br /> _ j� r �/ <br /> GENERATOR'S CERTIFICATION:I hereby cerby that the above named material is not a hazardous <br /> waste as de8ned'by 40 CFR Pad 261 or the 22 of the California cote of regulations,has been properly <br /> described.classified and packaged,and is in proper condition for transportation asording to applicable <br /> regulations:AND,If the waste Is a treatment residue of s praylously reatrtcted hazardous waste <br /> subject to the Land Disposal Restrictions,I cedity and warrent that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFP Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTF.TYPE: <br /> ISPOSAL ❑SLUDGE <br /> O CONSTRUCTION ❑WOOD <br /> O DEBRIS O OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> �1C)g I A(Ous e (?v�y <br /> at A! <br /> TRANSPORTER NOTES: I VEHICLE LICENSE NUMBER' TRUCK NUMBER <br /> nm� " este 10 1 O 0 TS 7. <br /> ADDRESS <br /> ? O tJc-L <br /> CITY, STATE,ZIP <br /> U r vt zoCr C.3 r GS 92 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> d — ❑ ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS 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 DISPOSALMETHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> REMARKS O SOIL <br /> ❑ CONSTRUCTION <br /> FACILITY TICKET NUMBERDEBRIS <br /> f' ❑ NON-FRIABLE <br /> ^ , ASBESTOS <br /> SIGNATURE OF AUTHOR IZED.-AGENT DATE <br /> dillt f ❑ SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PfIi1060`:00 F-d.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 /> MANIFEST# 50006 <br /> ro aniconorcc rnov <br />