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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island [v1"'Forward <br /> Sanitary Landfill Scoary Landfill Sanitary L&fill Landfill <br /> 901 Bailey Road 12 San Mateo Road 1601 Dixon Lan-Ung 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 /> =ax(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 /> Sci C =&e. <br /> MAILING ADDRESS S� <br /> a�-la,1 Li r+ <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> e.0 q4 , <br /> PHONE ❑GLOVES ❑GOGGLES ❑RESPIRATOR O HARD HAT <br /> u 1 <br /> 9-73 -77 Lf S O TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> Fey,,-C_{ SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT TITLE JDATE <br /> GENERATOR'S CE^ IFICATION:I hereby certify that the some named material is not a hazardous <br /> waste as defined by 4t* Fq Pan 261 or title 22 of the California code of regulations,has been properly <br /> descnbetl,desaitietl an ackagad,and is in proper wroition for transportation a-cordmij to applicable <br /> regulations;AND,II the waste Ie a treatment residue of a prwfouay restricted hazardous waste <br /> subject to the Land Disposal itestricuons,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Pan 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WAST9 TYPE: <br /> &DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 9y09l�ALf OL-trty\. /7015:. RJI/ <br /> Z\� <br /> TRANSPORTER I NOTES: VEHICLE LICENSE NUMBER TRmm UCK NUMBER <br /> ADDRESS r <br /> ~5TH <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 3 K_ 1'40-7 <br /> ❑ ❑ 1. ,I]..; <br /> SIGNATURE OF AUTHOR[ZED AGENT ORDRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> %� ❑ ❑ ❑ ❑ <br /> r <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 /> REMARKS ❑ SOIL <br /> ❑CONSTRUCTION <br /> FACILITYTICKET NUMBER DEBRIS <br /> 0.NON-FRIABLE <br /> SBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT ATE <br /> WOOD <br /> ❑ASH <br /> '��;�.�.- �i';•• ,"`� �' ,'��Z S' ❑ SPECIAL OTHER <br /> SCH COLING MUST EE,MADE PRIORTO3:4:0 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 BEFORE. <br /> MANIFEST* ; <br /> Tcz Af.1.4PnRTFR ra7PY 59008 <br />