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❑ 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 /> -Y, 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.c <br /> aci e <br /> MAILING ADDRESS <br /> Stop °, 4 <br /> 314 <br /> CITY,STATE,:ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Sas IKrr s�w,CA 94120 U GLOVES ❑GOGGLES U RESPIRATOR U HARD HAT <br /> PHONE <br /> at -' U TY-VEK U OTHER <br /> CONTACT PERSON SPECIAL ANDLING PROCEDURES: <br /> Tis G�,�v <br /> SIGNATURE OF AUTHORI ED AGENT/TITLE DATE UZ <br /> Y <br /> Im � <br /> r t� <br /> GENERATOR'S CERTIFICATION;I he by ortily that the above named material is not a hazardous <br /> `.'waste as defined by 40 CFR Part 261&,V22 22 of the California code of regulations,has been propedy <br /> described,classified and packaged,and is in proper condition for transportation a-cording to applicable - - <br /> regulatans;AND,If the waste Is a treatment residue of a previously restricted hazardous waste <br /> �aublectto the.Land Disposal Restrictions,l certify and warrant that the waste has been treated in RECEIVING FACILITY - <br /> accordance with the requirements of 40 CFR Part 268 aril is no longer a hazardous waste as defined by <br /> =%4o CER Part 261. <br /> WAS E TYPE: <br /> h <br /> 5P SAL Ll SLUDGE <br /> LLCONSTRUCTION O WOOD <br /> F3;DEBR15 U OTHER <br /> ' 0`SPECIAL WASTE , <br /> GENERATING FACILITY <br /> :7 Ll r s roP 16kye for on 1A! fRCIP <br /> r RANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> <br /> <br /> Fes ' <br /> 320_ g?w.t Court � <br /> CITY,STATE,ZIP ..> /t CI±CGEV��7 � <br /> U s r,CA 9549 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> !h)i)333-11401 ❑ Q <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROL -OFF(S) FLAT=BED VAN DRUMS <br /> <— a ❑ ❑ ❑ <br /> CUBIC YARDS <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 <br /> O SOIL <br /> REMARKS <br /> U CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER O NON FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> U ASH <br /> O SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIOR TO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> Tp REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST# 8 9 <br /> 7 8 <br />