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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island ;K. Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill ` Landfill <br /> 901 Battey Road_ 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> Pittsbu4gr CA 565 =Half Moon Ba CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> f. 94 Y. R <br /> Phone ft25t 58-9800 Phone{650)726-1819 Phone(408)945-2800 Phone(209).98Z-4298 <br /> t n Fax(925 4b&9891: Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> 71 Beek S`tree Mail 8")B24A 4314 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Son Fasc:o(_''A 94120 U GLOVES U GOGGLES U RESPIRATOR O HARD HAT <br /> PHONE` : _ <br /> (435)973-s?7i _ U TY-VEK U OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZ D AGENT/TITLE DATE �) y <br /> 74? GENERATOR'S CERTIFICATION:1 he nify 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 property_r described,classified and packaged,and is in proper condition for transportation according 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 Pail 268 and is no forigor a hazardous waste as defined by <br /> `.40 CFR Part 261. <br /> WASTE TYPE: <br /> DISPOSAL U SLUDGE <br /> U CONSTRUCTION U WOOD <br /> D DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> i.tthxag i�3VdrX"Station LAI-fit OP <br /> r RANSPORTER NOTES: VEHICLE LICENSE NUMBER --TRUCK NUMBER <br /> �3n3e to T _ lox <br /> - F�' 19 <br /> CITY, STATE,ZIP � f <br /> iVil'mC.:�' 954!"2 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (707)338-1407 <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <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 <br /> is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> U SOIL <br /> REMARKS <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> 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 PRIORTO 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 MANIFEST# 0 0 0-7 n 9 <br />