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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 /> t� Phone(925)458=9800 Phone(650)726-1819 Phone(408)9.45-2800 Phone(209)982-4298 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> f <br /> lk <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> ;i <br /> MAILING ADDRESS <br /> 4314 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> San Fc ;CA 34120 _- U GLOVES O GOGGLES U RESPIRATOR D HARD HAT <br /> PHONE <br /> J - U TY-VEK U OTHER <br /> CONTACT PERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZ D AGENT/TIT"L'E�� DATE N�lvC� <br /> .�- <br /> GENERATOR'S CERTIFICATION:I hereby that the above named material is not a hazardous . <br /> waste as defined by 40 CFR Part 261 or fide 22 of the California code of regulations,has been property <br /> >' described;classified and and is in r condition for transportation f�a9�. proper according to applicable <br /> regulations;AND,H the waste Is a treetrtterd ra{due of a previously restrkted Aezerdous waste - <br /> ,r subject to the Land Disposal Restrictions,I cert and warrant that the waste has been treated int--. - RECEIVING FACILITY 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 /> ISPOSAL U SLUDGE <br /> U CONSTRUCTION U WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> x; GENERATING FACILITY -- <br /> De1ry er S'fasi:.a L AI f MOP <br /> t <br /> F f RANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER' <br /> ADDRESS / , ��( <br /> 820 Dept r Comet' <br /> CITY,STATE,ZIP :: �; <br /> Winr.Iscx,CA 35492 ' �C45-", <br /> PHONE END DUMP BOTTOM DUMP TRANSFER : <br /> "70 838-1407 ❑. ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> lb /Cid <br /> L1 Q L11 <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 /> U SOIL <br /> EMARKS <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH <br /> U 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 /> f1_c%1c0Arno r`nov MANIFFST* ^^^ r-^A <br />