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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 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 /> n NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCENO. <br /> a c &Elect-ne <br /> n MAILING ADDRESS 431 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> ' 'baa Fz uascn,CA 94120 U GLOVES U GOGGLES U RESPIRATOR U HARD HAT <br /> PHONE <br /> 4 S773 U TY-VEK U OTHER <br /> CONTACT PERSON <br /> Robei.t Gray <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> F "GENERATOR'S CERTIFICATION:I kere certify that the above named material is not a hazardous <br /> -.waste asdefinedby 40 CFR Part261 or title 22 of the California code of regulations,has been properly <br /> described,classifiedandpackaged,and is in proper condition for transportation a-.cording to applicable <br /> '- regulations;AND,if the waste Is s treatment residue of a previously restricted hazardous waste <br /> subject to the land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 4t)CFR Part and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. - <br /> WASTE TYPE <br /> DISPOSAL U SLUDGE <br /> 4 ; U CONSTRUCTION U WOOD <br /> U;' O DEBRIS U OTHER <br /> O SPECIAL WASTE <br /> 7 GENERATING FACILITY <br /> 7,..i x��_ ,a�.. C �t�4S�S f�sn <br /> .x<rop.i1rJSydMt0r U it'," 3�f�1.i735 OP " <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUC "NO "BER <br /> >' ADDER E S Trsz • I ' j <br /> 5m'0 DenBatte CtIU t <br /> CITY,STATE,ZIP <br /> xO <br /> Windsor;CA 944 ? <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 70 $3$»2407 4Z ❑ ❑ <br /> SIGNATURE OF OR DRIVER DATE ROLL-OFFS) 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 /> U SOIL <br /> EMARKS <br /> U CONSTRUCTION •■ <br /> FACILITY TICKET NUMBER DEBRIS. U NON-FRIABLE • <br /> ■ <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 /> GENFRATOR(-OPY MANIFEST a n n n C n n .] <br />