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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 Halt Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(65%726-1819 Phone,{408)945-2800 Phone(209)982-4298 <br /> Fa*(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. <br /> a_ c t3 cmc <br /> ;+ MAILING ADDRESS <br /> ' e Street1 <br /> B-24A <br /> 431-4 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> v <br /> San Frs_ncscio,CA 941:20 U GLOVES, Q GOGGLES Q RESPIRATOR O HARD HAT <br /> PHONE <br /> 1 `3 Q TY-VEK Q OTHER <br /> CONTACT PERSON <br /> Rob+f.Gray SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT!TITLE DATE � }� <br /> "t t4 <br /> GENERATOR'S CERTIFICATION:.I herJq her - cenity 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 /> described,classified and packaged,and is in proper condition for transportation a-cording to applicable <br /> regulations;AND,If the waste Is atreatment residue of a previously restricted hazardous watts <br /> subject to the land Disposal Restrictions:I cenity and warrant that the waste has been treated in RECEIVING FACILITY <br /> 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 /> DISPOSAL U SLUDGE <br /> O CONSTRUCTION O WOOD <br /> U DEBRIS O OTHER <br /> U SPECIAL WASTE , <br /> ILITY <br /> Lsecag DL-ATHROP <br /> 1RANSPORT NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> V-0 DaIBCM,Court <br /> CITY,STATE,ZIP <br /> ,CA 95492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 707)838-1407 ❑ ❑ <br /> SIGNATURE OF AUTHO, ED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BEDVAN DRUMS <br /> f141 Alibl'o <br /> CUBIC YARDS <br /> 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 /> FACILITY TICKET NUMBER DEBRIS <br /> O NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH <br /> O SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL a 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 5ZQ A l 1 <br />