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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island For, <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill ; Lan( <br /> 901:Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9999S <br /> Pittsburg,CA 94565 Half Moon Bay,CA 94019 Milpitas,CA 95035 Mantec. <br /> Phone(925)458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(. <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(2091 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> y GENERATOR WASTE ACCEPTANCE NO. <br /> 1 4Vf1Lit,VOD L`C. J_i\rLt3 lL <br /> MAILING ADDRESS <br /> r: a'Ii <br /> Beale77 p <br /> ,- CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> syn Frrrlr_.icf o rA 94101 O GLOVES O GOGGLES U RESPIRATOR O HARD HAT <br /> PHONE <br /> O TY-VEK U OTHER <br /> CON&C T9 ERSON <br /> SPECIAL HANDLING PROCEDURES: <br /> Robcrt Ciray <br /> SIGNATURE OF ALIT ORIZED AGENT/ fTLE JDATE <br /> GENERATOR'S.CERTIFICATION:.I hereby certity 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 property - <br /> described,-classified and packaged;and is in proper condition for transportation a-:cording to applicable <br /> iegwatigns:ANR If the waste Is s treatment reafdue of a previously restricted hazardous waste <br /> subject to the wieirandDisposalRestnctt*4.&,nAyandwarrantthatthewastehasbeentreatedin RECEIVING FACILITY <br /> accordancth the mrILurements of 4d CFR Part 268 and is no"er a hazardous waste as defined by <br /> 40 CFR Part 261: <br /> WASTE TYPE: <br /> `DISPOSAL U SLUDGE <br /> O CONSTRUCTION U WOOD <br /> UDE$RkS U OTHER <br /> U, WASTE <br /> _jffiffG FACILITY <br /> 0tald®n itfirp <br /> NOTES: VEHICLE uCEEN-1W IN <br /> ADDRESS .. <br /> CITY STATE,ZIP <br /> Windsoir. CA 95492 <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> �r n� Or ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL'OFF(S) FLAT-BED VAN DRUMS <br /> `a 1 <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 /> U CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH <br /> U 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 REFUSALUPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST# q q j Q 7 I^ <br />