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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Islandforward <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 /> GENERATOR! WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> ?t 431-4 <br /> 3ede Strom A40 Stop R24.A <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Fan Frawisco SCA 94120 <br /> ❑GLOVES ❑GOGGLES ❑RESPIRATOR 0 HARD HAT <br /> PHONE <br /> 973-3773Q TY-VEK 0 OTHER <br /> CONTACT PERSON <br /> plow SPECIAL HANDLING PROCEDURES: <br /> Gray <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE Aj 61� L` <br /> GENERATOR's CERTIFICATION:I hereby ceW that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22ofthe California code of regulations,has been property <br /> des6ribed,classified and packaged,and is in proper motion for transportation a-tording to applicable <br /> regulations;AND,ff file waste Is a treatment residue of a previously restricted hazardous waste <br /> g ;.subject to the Caird Disposal Restrictions,l certify 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 Pah 261_ <br /> TETYPE: <br /> ISPOSAL Q SLUDGE <br /> " 0 CONSTRUCTION Q WOOD <br /> Q DEBRIS Q OTHER <br /> Q SPECIAL WASTE <br /> ENERATING.FACILITY <br /> L.+ b�UeI?�ilrfaioz txtiar► 1AT11ROP <br /> t R 'NSPORTER NOTES: VEHICLE LICENSE NUMBER TRP , MBER <br /> Icte T' - - <br /> <br /> 1#2o beiiB Cowl' <br /> CITY,STATE,ZIP LAY <br /> c�fi;CA 954-42 .' <br /> '? PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (707)238-1407L)11 - L) <br /> SIGNATURE OFAUTHORIZED AGENT OR DRIVER DATE ROLE-OFFS) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> h 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 /> Q SOIL <br /> EMARKS <br /> Q CONSTRUCTION <br /> FACILITY-TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> Q WOOD <br /> Q ASH <br /> "0 SPECIAL OTHER <br /> tdHEDULING MUST BE MADE PRIOR TO 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# 289590 <br />