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[� Keller Canyon ❑ Ox Mountain ❑ Newby Island 'jfForward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill r 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 /> • ICON-HAZARDOUS WASTE MANIFEST <br /> GENE C R _C +, WASTE ACCEPTANCE N0. <br /> MAILING ADDRESS Gi <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONE <br /> i - 'S—-7 dGLOVES U GOGGLES U RESPIRATOR U HARD HAT <br /> U TY VEK U OTHER <br /> CONTACT PERSON 46-aT- <br /> 1(,t _! r A.at// vee-r-5 _,;,JSPECIAL HANDLING PROCEDURES _ <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> r <br /> ✓ r' � -�� a�-`,��^.' <br /> r <br /> GENERATOR S CERTIFICATION I hereby certify that pre above named material Is not a hazardous <br /> waste as defined by 40 CFR Part 281 or title 22 of the California code of regulations has been property <br /> described classified and packaged and is In proper condition for transportation according to applk able <br /> regulabns AND,It the waste is s trestmerd residue of a previously restricted bazardaus waste <br /> subject to the Land Disposal Restrictions I certify and warrant that the waste has been treated In RECEIVING FACILITY <br /> as ortanee with the requirements of 40 CFR Part 268 and Is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ❑DISPOSAL Q SLUDGE <br /> ❑CONSTRUCTION U WOOD <br /> ❑DEBRIS ❑ THER <br /> ❑SPECIAL WASTE t�= <br /> GENERATING FACILITY <br /> TRANSPORTER,---,- w , r NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS ` <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENTiOR DRIVER DATE, r ROLL-OFFS FLAT-BED VAN DRUMS <br /> s <br /> CUBIC YARDS <br /> 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 /> ❑CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT- DATE <br /> ❑WOOD <br /> J r .p SPECIAL OTHER <br /> , <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 /> MANIFEST N c J_ <br /> rzcnhr=ae-MIR r`nPY <br />