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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island p Forward <br /> SanitarX.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 4l/tic,�o <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS ` <br /> lit 4`e_ lY f4113 2. .`CK,w i.yfL1 f, ' <br /> CITY STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> :'fats Rawc LCA 95483 <br /> O GLOVES 0 GOGGLES O RESPIRATOR O HARD HAT <br /> PHONE <br /> E5r<5 41i-.a is O TY VEK ❑OTHER <br /> CONTACT PERSON <br /> 1&1 .3vf.aT"010 SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE O�AUTHORIZED AGENT/TITLE Vp-- DATE <br /> �t`' ` I i .J CU i•i r'4� <br /> �/.--.`J'-...-..�. �i i_•••-•---..ice �'r i�.1.� ,� ••/ <br /> GENERATOR'S CERTIFICATION:I hereby corny that the above named material is not a hamdous <br /> waste as defined by 40 CFR Part 281 or title 22 of the California code of regulations,has been property <br /> described,dessR'ad and packaged,and is in proper condition for transportation a-cording to applicable <br /> regutad";AND,If the ware is a treatment residue of a previously restricted hazardous waste <br /> su*ct to ttw Land Disposal Restrictions.I co"and warrant that the waste has been treated In RECEIVING FACILITY <br /> accordance with 88 h the requirements of 40 CFR Part 2and is no longer a hazardous waste as defined by <br /> 40 CFR Part 281. <br /> WASTE TYPE: <br /> s O DISPOSAL O SLUDGE <br /> O CONSTRUCTION O WOOD <br /> O DEBRIS Q OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> P>'Walx. .k`topexv •-1.755 W. i.Ault S.rc-et: `11.Ac, <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS " 1 <br /> CITY,STATE;ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> 1 hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing <br /> Is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> EMARKS O SOIL <br /> N. O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ` ASBESTOS <br /> SIGNATURE OF AUTHORI D AGENT DATE <br /> '} J O WOOD <br /> O ASH <br /> O SPECIAL OTHER <br /> : QUL.ING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> i11?FUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> r TRANSPORTER COPY MANIFEST# 9 <br />