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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island --Forward <br /> Sanitary 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 /> no (925) 458-9800 Phone(650)726-1819 Phone (408)945-2800 Phone(209) 982-4298 <br /> t (925) 4558-9891 Fax(650)726-9183 Fax (408)262-2871 Fax(209)982-1009 <br /> V <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR C_0 V a Cox WASTE ACCEPTANCE NO. <br /> C/o ii sv r C E' & R-D f- fij <br /> MAILING ADDRESSLrT3 flX90(,V11,EA_D PE ? 7 <br /> _ <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> S;r GLOVES LI GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> PHONE <br /> U TY-VEK a OTHER <br /> CONTACT PERSON ,-Tilt -f <br /> SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE 001—,U E Aj T A M 1 N A e E7I�) f <br /> GEN ERATOA S CERTIFICAmN I hereby certify that the above named material Is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations has been properly <br /> described classified and packaged,and Is In proper condition for transportation a-cording to applicable <br /> regulations AND,If the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions I camty 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 /> ❑DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION ❑WOOD <br /> D DEBRIS Q OTHER <br /> ❑SPECIAL WASTE Ef SOIL- <br /> GENERATING <br /> OIL- <br /> GENNERATING FACILITY C D K ¢ COY �- f -- <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS 7 L� <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATUIPEVrWRIZINAQ.ENTOR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> * 6 2- <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 MEI-HOD (TO BE COMPLETED BY LANDFILL) <br /> Is true and accurate <br /> DISPOSE OTHER <br /> ❑ <br /> REMARKS SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑WOOD <br /> ❑ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3 00 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 /> C3RATOR COPY MANIFEST#1 50483 <br />