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Keller Canyon ❑ Ox Mountain ❑ Newby Island ' j 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) Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(925)458-9891 Fax(650)726-91.83 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENzE�RATOR ' WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> 77 ca S'UvA Std B�4A; <br /> 4314 <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Son Firmwisco,CA 94120 Q GLOVES Q GOGGLES ❑RESPIRATOR Q HARD HAT <br /> PHONE <br /> 7 Q TY-VEK Q OTHER <br /> CONTACT PERSON; <br /> Robal Gmy SPECIAL HANDLING PROCEDURES:SIGNATURE �-- <br /> OF AU ORIZED AGENT DATE N4 <br /> GENERATOR'S CERTIFICATION:I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properly <br /> described,classified and packaged,and is in proper condition for transportation a-Lording to applicable <br /> regulations;AND,If the waste Is a treatment realdue 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 40 CFR Part 2118 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> SPOSAL Q SLUDGE <br /> `U CONSTRUCTION 0 WOOD <br /> U DEBRIS U OTHER <br /> U SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1--all op Dehy&atm #icxs lArRROP <br /> TRANSPORTERNOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESST �� <br /> 920 D ~te Court <br /> CITY, STATE,ZIP <br /> WMdSkt,CA 9 - <br /> PHONE END DUMP BOTTOM DUMP TRARSFER <br /> 707)'83S+407/, ❑ ❑ aj <br /> SIGNATU9t:(YA!5HORIZED 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 /> U SOIL <br /> REMARKS <br /> D CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> Q NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> U ASH <br /> ❑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 />