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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(W5),458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> f <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> H. NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> t,* MAILING ADDRESS <br /> f' a B24A 431-4 <br /> CITY;STATE;ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> t San 0 ,CA 94120 0 GLOVES O GOGGLES 0 RESPIRATOR 0 HARD HAT <br /> PHONE <br /> ' 0 TY-VEK 0 OTHER <br /> CONTACT PERSON <br /> RdmtG y SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHOR D AGENT/TITLE DATE <br /> GENERATOR'S CERTIFICATION:`f her rtity that the above named material is not a hazardous <br /> waste.as defined by 40 CFR Part 261 or fitly 22 of the California code of regulations,has been property . <br /> described,dassified and packaged,and is in proper condition for transportation a-mcling to applicable <br /> . regulations,AND,M the waste Is a treatment residue of s previously restricted hazardous waste <br /> subject ro me Land Drsposaf Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> +i, ecCurdance with the requirements of 40 CFA Part 268 and is no longer a hazardous waste as defined by <br /> 4t}vFR Part 26T. <br /> WAS iTYPE: <br /> D BP.OSAL 0 SLUDGE <br /> a CONSTRUCTION, U WOOD <br /> ❑ 7EBRIS R <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY <br /> a <br /> LATMOF <br /> ` ; ER NOTES. `V�I�ICLE�IGENSE"NUMBER TRUCK NUMBER <br /> .. <br /> ADDRESS. <br /> U Dihtefe CMUt <br /> CITY,-STATE,ZIP ��T <br /> WWSMCA95492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> 7Q 1 .8*,1407 <br /> L) ❑ <br /> SIGNA EtE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <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 /> 0 SOIL <br /> EMARKS <br /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> 0 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 /> GENERATOR.COPY MANIFEST# O Q Q g Q 7 <br />