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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island FV 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,GA 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 /> - <br /> NON-HAZARDOUS WASTE MANIFEST ) <br /> GENERATOR <br /> WASTE ACCEPTANCE NO. <br /> G, <br /> AILING ADDRESS r <br /> e 3 <br /> SWp a A <br /> 1-4 <br /> CITY;=STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> auFt�aci MCA94120 O GLOVES ❑GOGGLES b RESPIRATOR O HARD HAT <br /> PHONE- _ <br /> ) 770 TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> Robed Gray SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> NO <br /> N <br /> 1 ;1b`U <br /> GENERATOR'S CERTIFICATION:I he y cedity 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 /> e described,.classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> r regulattons`ANR If the waste Is a treatment residue of a previously restricted hazardous waste <br /> subtest b the,Land Disposal Reytrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> ascgrdancew@h the requirements of 40 CFR Pad 268 and is no longer a hazardous waste as defined by <br /> :110CFR Part 261. <br /> /ATE TYPE: <br /> DISPOSAL D SLUDGE <br /> u N 0 WOOD <br /> UD EBRIS O OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> 4: <br /> DehY raio�Station, 1.AfHROP <br /> NOTES; 'VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> r Y Tr... <br /> ADDRESS <br /> 320 T)enBeste Cwt <br /> CITY,STATE,ZIP j <br /> Wm_dsmCA 45492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> '70 838-1407 ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROL -OFF(S) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <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 <br /> EMARKS SOIL <br /> ❑CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER o NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> r <br /> ❑ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 RM.THE DAY PRIOR TO EXPECTED ARRIVAL o 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 Q Q A n 7 <br />