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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island MForward <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)945.7-2800_ 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 /> sl GENERATOR WASTE ACCEPTANCE NO. <br /> s> as&EWI-.ic <br /> t MAILING ADDRESS <br /> 77 .see tavA <br /> 14 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> san FrkncismCA 94120 <br /> SHONE` D GLOVES Q GOGGLES Q RESPIRATOR Q HARD HAT <br /> J 5,73-3 7 73 Q TY-VEK Q OTHER <br /> CONTACT PERSON <br /> Robel1,Gray SPECIAL HANDLING PROCEDURES: <br /> ;L SIGNATURE OF AUT ORIZED AGENT TITLE DATE ru o At <br /> GENERATOR'S CERTIFICATION:1 hereby certify that the above named materials not a hazardous 7 <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 packaged,and is in proper condition for transportation a-cording to applicable <br /> regulations;AND,tf the waste Is s treatment residue of a previously resfrkted hazardous waste - <br /> k sub t to"Land Disposal:Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY - <br /> accordance with ft requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> E: <br /> ISPOSAL Q SLUDGE <br /> Q CONSTRUCTION Q WOOD <br /> O DEBRIS Q OTHER <br /> Q SPECIAL WASTE <br /> (NG FACILITY <br /> LATMOP <br /> �Rdfi�y POR. ..- <br /> NOTES: VEHICLELICENSE NUMBER TRUCK NUMBER` <br /> ADDRESS <br /> 820 Df;-iBeste Cotut <br /> CITY,STATE,ZIP <br /> A 9 5492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> (707)83$-'1067 / ❑ ❑ <br /> SIGNAT)056 OF HORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> I 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 /> Q NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> Q WOOD <br /> Q ASH <br /> Q SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIOR TO 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 /> C,FNFRATnR rnaY MANIFEST# n n Pl n n A <br />