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❑ Keller Canyon ❑ Owountain ElNewby ISI d �Forward <br /> Sanitary Landfill S ary Landfill Sanitary t�dfill 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 4 WASTE ACCEPTANCE NO. <br /> � Gh <br /> MAILING ADDRESS <br /> 72 <br /> qg ; c Lia <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE ..n J a > A LOVES ❑GOGGLES ❑RESPIRATOR HARD HAT <br /> ❑TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> i'7 r'cA,e en SPECIAL HANDLING PROCEDURES: <br /> SIGNATU E OF AUTHORIZED AGENT/TITLE DATE 0 <br /> Acf�a G.o <br /> * <br /> ��A A ,eanMe+sa( 6LA9j_r04 <br /> GE TOR'S CERTIFICA110N�1 handy oenabovemmrial not that Me named material na hazardous <br /> was a as defined by 40 CFR Pan 261 or title M.1 ft Calilomu old,d regulations,has Men propertydescnMtl,classified arW packaged,and u in proper mrMitbn tor tans portation amordmo to applirada <br /> regule4wu;AND.It Ills waale Is a trMblNnt rrWw of•pmbwly reabbfad MnNope waab <br /> Subject to the land Disposal Restrictions,I mfdty and warrant that the waste hes Men treated in <br /> accordance with the reguirementa of b CFR Pan 266 end iS no longer a hazardous waste as defined by RECEIVING FACILITY <br /> 40 CFR Pad M. <br /> WASTE TYPE: <br /> ❑DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION O WOOD <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING(� �q'�FACILITY <br /> 3�U l4�Plh 141-71 VOr-a o S'lt'sr_c,t <br /> moommmonommo�TRANSPORTER ri NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS 3VV3IR j Z <br /> O o _ <br /> CITY, STATE,ZIP <br /> ac��on CA Sal <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 09- (o�- CSG2G ❑ In <br /> SIGNATURE OFAUTHORIZED AGEN 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 DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate. <br /> DISPOSE OTHER <br /> R <br /> EMARKS ❑ SOIL <br /> ❑ CONSTRUCTION <br /> ET NUMBER DEBRIS <br /> ❑ NON-FRIABLE <br /> ASBESTOS <br /> F AUTHORIZED AGENT DATE <br /> O WOOD <br /> ❑ASH <br /> ❑ SPECIAL OTHER <br /> HEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL+ANY UNSCHEDULED LOADS ARE SUBJECT <br /> too <br /> REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> MANIFEST# 39635 <br />