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❑ Keller Canyon ❑ Oountain El Newby ISI d Forward <br /> Sanitary Landfill S ary Landfill Sanitary Ipdfill 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 /> GENERATO WASTE ACCEPTANCE NO. <br /> IkI il,c c e 77 <br /> MAILING ADDRESS <br /> ,z- 72m -S . n v <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> GLOVES ❑GOGGLES O RESPIRATOR HARD HAT <br /> PHONE <br /> O TY-VEK l7 OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATUREOFAUTHORIZEDAGENT/TITLE DATE <br /> /I�dJPACP <br /> �EA 0LHP40i: <br /> GE BATOR'S CERTIFICATION:I hereby cediy that the above named materiel u not a hazardous <br /> waste as defined by 40 CFR Part 261 a title 22 of he Calibma code of regulators,hes been properly <br /> described,classified and packaged.and is in proper condition for transportation according b applicable <br /> regWafiam;AND,If Me eraata Is a traabrrare rescue of a pmbusly rpbicbd hazardous wpb <br /> subject to tie Lard Disposal Restrictions,I candy and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance wiM the refuiremd 4p es s CFR Pan 268 and is no longer a hazardous waste as defied by <br /> n <br /> 40 CFA Pan M. <br /> WASTE TYPE: <br /> ❑DISPOSAL O SLUDGE <br /> 0 CONSTRUCTION ❑WOOD <br /> O DEBRIS O OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY l /r 1 <br /> 3 � 4dF j F! <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS J <br /> CITY,STATE,ZIP <br /> S't^.C. , /Vie <br /> PHONEEND DUMP BOTTOM DUMP TRANSFER <br /> Lot (� o cr. <br /> SIGNATU E OFAUTHORIZED AGENT OR DRIVERU 4W <br /> DATE ROLL-OFFS FLAT-BED VAN D UMS <br /> ❑ ❑ ❑ ❑ <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 O SOIL <br /> ❑CONSTRUCTION <br /> FL1YET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SFAUTHORIZEDAGENT DATE - <br /> 0 WOOD <br /> O ASH <br /> ❑SPECIAL OTHER <br /> HEDULING MUST BE MADE PRIORTO3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> O REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> MANIFEST* 39634 <br />