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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island 1C Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9909S.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 Phonet209)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 <br /> &E6-- WASTE ACCEPTANCE N0. <br /> OW MAILING ADDRESS <br /> 7 e pert�tai1 Stop B24A <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Rr tisrc�CA 94120 O GLOVES ❑GOGGLES O RESPIRATOR U HARD HAT <br /> PHONE <br /> 415 973-37T3 O TY-VEK ❑OTHER <br /> CONTACT PERSON <br /> R SPECIAL HANDLING PROCEDURES: <br /> Gray <br /> SIGNATURE OF AUTHORI D AGENT/TITLE DATE <br /> f <br /> GENERATOR'S CERTIFICATION:I hereby r dy that the above named material is not a hazardous <br /> �sa5te b5 defined by 40 CFR.Part 261 or title 22of the Califomiacode of regulations,has been property - <br /> dassified and pat, ged,and is in proper condition for transportation a-cording to applicable <br /> s�tagutd6ons,AND,'h the wets* r treatment residue of s prevlousty restricted hazardous waste <br /> to the land F{@shrctions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> steel, Drsposaf <br /> �.8ecordartce write the requttetnertts of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> WASTE TYPE: <br /> DISPOSAL U SLUDGE <br /> CQNSTRUCTION. O WOOD <br /> O'DEBF#IS` ❑OTHER <br /> O <br /> GE(VERATING FACILITY <br /> r <br /> m or Mice LA'111ROP <br /> NOTES:. `VEHICLE LICENSE NUMBER "' TRIfCkN1PNIER"" <br /> Court i <br /> Il 1(,STATE;ZIPr <br /> GVirgd r'CA 95432 <br /> 1?HONE END DUMP BOTTOM DUMP TRANSFER <br /> (707)838-1407 ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <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 /> I, <br /> 0 SOIL <br /> f.tEMARKS <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> 0 NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> 0 ASH <br /> O 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 /> GENERATOR COPY MANIFEST# 2 8 g 5 q <br />