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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 /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> F GENERATOR WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> 77 Beale S-tre4 'W4314p I324A <br /> '° CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> 3tut Pramco 0:15.4;?0 ❑GLOVES 0 GOGGLES 0 RESPIRATOR L1 HARD HAT <br /> PHONE <br /> -37,3 U TY-VEK 0 OTHER <br /> CONTACT PERSON <br /> RoheA <br /> Grhv SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE BZW P <br /> � lr <br /> GENERATOR'S CERTIFICATION:I her certify that the above named material is not a hazardous <br /> waste ai;defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been property <br /> describo,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> Y? regulatiorts;AND,it the waste Is s treatment residue of a previously restricted hazardous waste <br /> subject,lathe Land Disposal Restrictions,1 certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> ? . accondahce with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as definedby. <br /> r40.CFR Part 261. <br /> WASTE TYPE: <br /> 1k DISPOSAL O.SLUDGE <br /> 5. .. -O CONSTRUCTION 0 WOOD <br /> v. <br /> O DEBRIS 0 OTHER <br /> OSPECIAL WASTE <br /> ENERATING FACILITY <br /> rri t P <br /> H . _ NOTES: VEHICCE'LIGE�S td�fMBER TRUCK NUMBER <br /> ITY_STATE,ZIPtV, p <br /> W CA 95492 �� Ey,jt ara �_ <br /> r <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (1 83&1407 ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS, <br /> f ❑ ❑ ❑ ❑ <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 /> O SOIL <br /> REMARKS <br /> O CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER <br /> A- O NON-FRIABLE <br /> p' ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> ❑ASH <br /> LI 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 9 9 Q Q r n In <br />