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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island OlForward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road ! 1 <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 i <br /> Fax(925)458-9891 Fax(650) 726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> LGENERATOR <br /> T> ; ,, rv1__ WASTE ACCEPTANCE NO. <br /> .ac,f c , <br /> NG ADDRESS <br /> street 1(Inn— <br /> 77 TAinale t?117 <br /> STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Sa Franc iar.o C`A 9'11 7.O U GLOVES O GOGGLES U RESPIRATOR O HARD HAT 1 I <br /> PHONE <br /> I <br /> U TY-VEK U OTHER I <br /> CON O' <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGN HORIZED AGENT/TITLE DATE <br /> AlAfiorized Agent for <br /> `/ ifs Cy�s.4c Eloch3c ......,....., <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous 1 V Vlle <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property <br /> described.Gassified and packaged,and is in proper condition for transportation a-cording to applicable r <br /> regulations;AND,if the waste Is a treatment residue of s previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY i <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 /> WA TE TYPE: t <br /> it <br /> DISPOSAL O SLUDGE I 1 <br /> CONSTRUCTION ❑WOOD <br /> ❑DEBRIS U OTHER <br /> O SPECIAL WASTE j <br /> GENERATING FACILITY I <br /> nmulon DuhydraLm iirvrnion <br /> i ASPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER III <br /> Uenf ieste Transvortawn / f <br /> ADDRESS <br /> R20 T ,�n}�c�ste. C`.t, <br /> CITY,STATE,ZIP <br /> WindRor CA - iI <br /> PHONE END DUMP BOTTOM DUMP TRAN F R <br /> ❑ ❑ <br /> SIGNRTU AU ORIZED ENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> ve <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. k <br /> DISPOSE OTHER E <br /> ie <br /> 0 <br /> REMARKS SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> • O WOOD <br /> U ASH <br /> O SPECIAL OTHER <br /> :HEDULIN¢'MUST BE MADE PRIORTO 3:00 P.M.THEDAY.PIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT p <br /> REFUSAL,UIPO.N Al RIVAL gjl,4 ING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE, <br /> GENERATOR COPY MANIFEST# 341921 1 <br />