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0 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 /> 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 <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> Vacs -c. •.3iay ter: ,,,,iii,aia{w <br /> MAILING ADDRESS77 Beale Strfect Mail Code B24�_,'� <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> _,oast vr;nctar:re ;a, 94111 t <br /> PHONE Q GLOVES Q GOGGLES O RESPIRATOR Q HARD HAT <br /> 4l.5) 973-3.773, Q TY-VEK Q OTHER <br /> CONTACT PERSON <br /> Ro t.n Grav SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT!TITLE DATE <br /> �alinuric+x .ir,cut tot, <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 266 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> Q DISPOSAL U SLUDGE <br /> Q CONSTRUCTION Q WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> y .'SSP.1117 af14..t.1..iSi4'�i,':�1.R.i34+2i•3 .d. :£t' Zfiit.l3i. <br /> } TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> - <br /> ADDRESS <br /> CITY, STATE,ZIP <br /> wilicLsor, C'/1 9541")2 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (7107)XM­140^7 ❑ ❑ A <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN D UMS <br /> ❑ ❑ ❑ ❑ <br /> c <br /> 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 /> EMARKS U SOIL <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> ❑WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 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 /> MANIFEST# F <br /> G �.F�=Zi"�i OR GGrY 3 �.,ii.. m,� <br />