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J Keller Canyon ❑ Ox Mountain ❑ Newby Island (, Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill i <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 f <br /> If�UI <br /> iNERATOR WASTE ACCEPTANCE NO. ' <br /> 1 at+t llV V4"" <br /> Lil\�Vu1.V <br /> ULING ADDRESS A nntI— " <br /> 77 Reals .rtreot �t=ave <br /> IY STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT I <br /> San Fraigcig i C.A 941 W) U GLOVES U GOGGLES U RESPIRATOR U HARD HAT <br /> SONE ! i <br /> U TY-VEK U OTHER <br /> NT'• ER O <br /> Robert Ckav, SPECIAL HANDLING PROCEDURES: f <br /> 3NATURE OF AUTHORIZED AGENT/TITLE DATE I <br /> Attdttmized Agent fbr <br /> race Lias&Flectrit .... .. . <br /> NERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous 1 V IJ[lt <br /> tate as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property i scribed,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> puiations;AND,If the waste is a treatment residue of a previously restricted hazardous waste <br /> biect to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> cordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> CFR Part 261. I l <br /> 1STE TYPE: <br /> O DISPOSAL U SLUDGE <br /> O CONSTRUCTION U WOOD <br /> O DEBRIS LI OTHER <br /> ❑SPECIAL WASTE <br /> :NERATING FACILITY <br /> nurnton Duhydrattor itumton <br /> W 1 t <br /> AN JRTER NOTES' VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> L)enl3este'l'rausportafton <br /> DRESS 1 <br /> _ _:n Pete _t- <br /> FY, STATE,ZIP / I <br /> -, 95492 <br /> ONE END QVMP BOTTOM DUMP TRANSFER <br /> t( n R - n ❑ ❑ <br /> !NATURE OFA THO ED AGENT OR DRIVER DATE RO - F(S) FLAT-BED VAN DRUMS 1 <br /> ❑ ❑ ❑ ❑ 1 <br /> CUBIC YARDS �bfl t <br /> 1 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 {{I <br /> I <br /> MARKS O SOIL f: <br /> l <br /> U CONSTRUCTION <br /> GILITY TICKET NUMBER DEBRIS <br /> i <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> iNATURE OF AUTHORIZED AGENT DATE tf u l <br /> O WOOD <br /> O ASH <br /> U SPECIAL OTHER <br /> KJLING MUST BE MADE PRIORTO 3:00 RM.THE DAY PRIORTO.EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> .FUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR DOPY MANIFEST# 341916 <br />