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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,CR 94565 Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> PhOh•(S25j 458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax( 25)45&9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR' WASTE ACCEPTANCE NO. <br /> I Fketric <br /> AILING ADDRESS <br /> € e.Street, " S t V B24A <br /> 1-4 <br /> CITY3`1f%!4TE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> U GLOVES O GOGGLES 0 RESPIRATOR O HARD HAT <br /> is P10NE <br /> l` - U TY-VEK U OTHER <br /> CONTACT PERSON <br /> Robed G1tibY SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORI ED AGENT/TITLE DATE <br /> I , <br /> GENERATOR 5 CERTIFICATION.I here c ry that the above named materiai is not a hazardous <br /> ;. Qned by 40 CFR Part 261,a title 22 of the California code of regulations,has been property <br /> packaged and.is in proper condition for transportation a-cording to applicable <br /> �. ANq H waste Jas treatment rcstdue of a previously restricted hazardous waste <br /> strbleci_bthetar�d:>�Restnctrons,tcettyand warrant that the waste has been treated in RECEIVING FACILITY <br /> i k mccoidattce with tFie ragwr§rtleitls o1 on CFR Pan 268 and is no longer a hazardous waste as defined by <br /> x .40 CFA. X61 <br /> YPE: , <br /> ISPQSAL U SLUDGE <br /> CONSTRUCTION U WOOD <br /> UiDEBRIS O OTHER <br /> Q;SPECIAL WASTE:. ; <br /> �El`(E 0 "' AM WATY <br /> i3`t$#itXi: LATMOP <br /> NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ZIP C CtJ <br /> :u d vi,A 9549' <br /> �HQNE < : END DUMP BOTTOM DUMP TRANSFER <br /> (707`$1-8-1407 ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> : ,_ ❑ ❑ ❑ ❑ <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 /> EMARKS o SOIL •, <br /> U CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER UNON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> 1 <br /> O ASH I <br /> U SPECIAL OTHER <br /> S.GNEDULING 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# <br />