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h <br /> Sep 13 OP 08: 06a Greta and/or H. B. Dietz 209-833-1288 p- 1 A <br /> ❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island .2"Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9998 S.Austin Road <br /> Pittsburg,CA 94565 - Half Moon Ba CA 94019 Mil Manteca,CA n Road i <br /> ,,. Milpitas,CA 96035 <br /> Phone(925)458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(925)458-9891 Fax(850)726-9183 Fax(408)262-2871 Fax(2 09)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS 14 <br /> CITY,STATE,ZIP = �; '6 REQUIRED PERSONAL PR TECT'IVE EO IPMENT <br /> f=r:� PHONE ?,•. ❑GLOVES ❑GOGGLES ❑RESP[RATOR d HARD HAT <br /> `lo' ❑TY--VEK 0OTHER <br /> CONTACT PERSON 4! - � :�_� ,' <br /> SPECIAL HANDLING PROCEDURES: <br /> [ SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> (3F1JERATOR'8 C6 rnFICAn6k l hereby carlify that the abase named malarial Is nal a hazardous - <br /> _:_ .waste as defined by 40 CFR Part 281 or Oils 22 of the Caslomls code of re"ilone,has been prcpeMy • <br /> f=� described,cteaelftad and packaged,and is In proper corldhlon for trargmlatlon aroord[N to applicable <br /> - repulalbns;AND,K the wasts Is a lnattgen!nsldus of a PrMlOusly nstHcW hazardous waste <br /> .m <br /> Bd to the Land Dbpcael Rastridlana,t cartlly end warrant that the wane has been heated In <br /> amordancs V*h Iho rsgWrements d 40 CFR Pan 259 and Is na lonyar a hazardous wasle as defined by RECEIVING FACILITY <br /> --40 CFR Pan 261. IJ <br /> :i <br /> WASTE TYPE: , <br /> ❑DISPOSAL O SLUDGE <br /> ❑CONSTRUCTION 0 WOOD { <br /> ❑1]E8R19 O OTHER <br /> - . 134PECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES: I VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> 'Ff <br /> ADDRESS <br /> CITY,STATE "-" <br /> ,ZIP <br /> r x <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE DF AUTHORIZED AGENT OR DRIVER DATE —ROLL-OFF S FLAT BED VAN DRUMS <br /> LlL <br /> CUBIC YARDS 1 <br /> 1 hereby certify that the above named material has been <br /> _j accepted and to the best of my knowledge the foregoing OSAL METHOD: (T p BE COMPLETED BY LANDFILL <br /> Is true and accurate. p1SP ) <br /> DISPOSE OTHER <br /> EMARK$ Q:OIL <br /> I: <br /> 0 CONSTRUCTION ' <br /> FACILITY TICKET NUMBER DEBRIS r <br /> - ' 0 NON-FRIABLE <br /> :1 SIGNATURE OFAUTHORIZED AGENT , DATE. ASBESTOS <br /> {. 0 WOOD IE ; <br /> ❑ASH <br /> ❑ SPECIAL OTHER <br /> iEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> T6 REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST Big SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST� �til��7 <br /> j <br />