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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 /> P)tttsburg,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(>'25)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> JGENFEERATOR WASTE ACCEPTANCE NO. <br /> JA4 %-A"4N.JU A46rt111.rG ADDRESS <br /> +�vy <br /> CITY,STATE,ZIP , REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE 4an firandqro, A 9 . ?0 O GLOVES O GOGGLES 0 RESPIRATOR 0 HARD HAT <br /> -- 0 TY-VEK 0 OTHER <br /> CONTACTPER90W <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> Atd uitized Aged for <br /> ific <br /> Pac &lecrt is ............. <br /> jp l .....Iky- <br /> GENERATOR'S CERTI TION:I hereby certify that the above named material is not a hazardous i"114.11fie <br /> waste as defined by 40 CFR Part 261 or title 22 of the Califomia code of regulations,has been property <br /> described,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> regulations;AND,N the waste is a treatment residue of a previously restricted hazardous waste <br /> subject to the land Disposal Restrictions,I certify and warrant that the waste has been treated in by RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Pan 268 and is no longer a hazardous waste as defined <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> 0 DISPOSAL 0 SLUDGE <br /> O CONSTRUCTION 0 WOOD <br /> O DEBRIS 0 OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> T"nurntvn%�aiyc�'aivc T��rnicrn <br /> ;RANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> L)enBeste1ransportation. - <br /> ADDRESS V,-2 2 Y, -;U 0 �72 <br /> 820_P_._ _tP_. CL t <br /> CITY,STATE,ZIP <br /> WindsM ry <br /> A 95492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ( AR-114 ❑ ❑ 91 <br /> SIGNATURE OF AUTHORIZED AGENTOR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN 'DRUMS <br /> J. 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 /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> O WOOD <br /> 0 ASH <br /> 0 SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL..ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST# 3419006" <br />