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r ° ❑ Keller Canyon ❑ Ox Mountain El Newby Island ,Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill landfill. <br /> 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> r <br /> 5. Half Moon Bay,:CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> X925 X800 Phone(656)726-1819 Phone:(408)945 2800 Phone(209)982 4298 <br /> 45&9891. Fax(650)72679183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> 1 WASTE ACCEPTANCE N0. <br /> MAILING ADDRESS <br /> . IS24A 43 <br /> 14 <br /> - _ r <br /> CITY,STATE, ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Franca ,CA 941211 <br /> 0 GLOVES U GOGGLES 0 RESPIRATOR O HARD HAT <br /> PHONE , <br /> t t .f 3-3777 3 U TY-VEK U OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> Robeft(k" <br /> SIGNATVPE OF AUTHOR IZEP AGENT/TITLE DATE `'Vo/V <br /> GENERATOR'S CERTIFICATION:.1 hereby that the above named material is not a hazardous, <br /> waste as defined by 40 CFR Part 261 or titlit.X of the Califomia code of regulations,has been property <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 s previously restricted hazardous wasti - <br /> subject to the Land Disposal Rostrictions,l certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> ,c- 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 /> ISPOSAL O;SLUDGE <br /> U CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1.sth"Dehydratcc Statim L.ATI.OP <br /> t RANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUM E'T <br /> DenBesle Tran: mtatico- <br /> <br /> i7 i��sBes~te Court <br /> CITY,STATE,ZIP <br /> r, <br /> VHONE END DUMP BOTTOM DUMP TRANSFER <br /> n;(707)338-1407 <br /> ❑ ❑ <br /> SIGNATURE UTHORIZED OR DRIVER DATE ROLE-OFF(S) FLAT-BED VAN DRUMS <br /> i <br /> CUBIC DS <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 /> U SOIL <br /> REMARKS <br /> U 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 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# {7 A t-1 C%7 <br />