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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island 4�1 Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landf1If Landfill <br /> 901 Dailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S Austin Road <br /> P*burg, CA 94565 Half Moon Bay, CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> 10*Phone (925),158-9800 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 /> FGENERATOR Ce x- -t-- WASTE ACCEPTANCE NO. <br /> �,Q N! C.G ADDRESS 7 <br /> TATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> SE, 14,54-A5jQA_ C GLOVES 0 GOGGLES O RESPIRATOR ❑ HARD HAT <br /> PHONE <br /> ❑TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> f-16H7 SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE 0,6�4 C'Aw7-A/tliAIA 7—FD So L <br /> 0A7-1412-c7ou5 <br /> GENE R'S CERTtFICATIaN I hereby certify that the above named material Is not a hazardous <br /> waste ad defined by 40 CFR Part 261 or htle 22 of the California code of regulations has been property <br /> described classitfed and packaged and Is in proper condition for transportation a-cording to applicable <br /> regulations ANA if the waste is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions I cartify and warrant that the waste has been treated In RECEIVING FACILITY '� / � <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> 0 DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> ❑DEBRIS ❑OTHER <br /> ❑SPECIAL WASTE A 501 L-Lk4 oN- A <br /> GENERATING FACILITY ifd <br /> tEADDREESS <br /> F'ORTER R NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> CITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED GENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> 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 /> SOIL <br /> REMARKS ❑ soi <br /> ❑ CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U�NON-FRIABLE <br /> fLASBESTOS <br /> SIGNATURE OF AUTHORIZEb AGENTDATE <br /> C]WOOD <br /> ,F r ❑ASH <br /> ❑ SPECIAL OTHER <br /> SCHEDULING MUST SE MADE PRIOR 00 P M THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO RIIFUSAL UPON ARRIVACONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> AO GENERATOR COPY MANIFEST#1 50476 <br />