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U Keller canyon U ux mountain LJ IVeWDy islana rorwaro <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 /> 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)982-1 C09 <br /> '. NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> Ac11�i�A� VQ{I �K. 1�.!Or1.lA 14. <br /> MAILING ADDRESS •nnr�— <br /> 77 BSyal.e Sti'ee4 Tviail D)dC B24A -t 111):;y <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> S ir'- -ra-ndsl ), CA 941' <br /> --' } U GLOVES ❑GOGGLES O RESPIRATOR O HARD HAT <br /> PHONE <br /> (4•5)973-3773 ❑TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> 'O 4rt Grav SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AU HORIZED AGENT/TITLE DATE <br /> *! / i lt• 1 1)aciiic Gari&Elccttia <br /> i <br /> GENERATOR's CERTIFICATION: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 certify 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 U SLUDGE <br /> U CONSTRUCTION U WOAD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> ��➢tJi7'r,s:7F"1 itu4�;'tt3"�@i°:'' i II.(bTAll;lfti. <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> i.i -I.a.sr -8:6:• lady,i.3}.! 0.t,)tp ".'� .: ( 7f)'7 �F.-I s,Ji/) ' <br /> ADDRESS f, L C�I _ v iJ is <br /> ap Pk 3 ♦: _ jr <br /> CITY,STATE ZIP # j r <br /> PHONE END'DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> f 1J ref'` ❑ ❑ ❑ ❑ <br /> P f <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. <br /> DISPOSE OTHER <br /> U SOIL <br /> REMARKS <br /> ❑CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIOR TO 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 /> GENERATOR COPY <br /> MANIFEST# 341874 <br />