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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island A,'Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill a 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 /> -max(925)458-9891 Fax(650) 726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENE T R C'9 ,� -A 0 WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS _ <br /> / 5-9 1 =� T_ ,{Z <br /> CITY, STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> " .- <br /> PHONE ! GLOVES ❑GOGGLES ❑RESPIRATOR U HARD HAT <br /> ❑TY-VEK ❑OTHER <br /> CONTACT PERSON :y,C -- <br /> J ,E-/zEC -SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE ' !�- •' '� -�c?` f- <br /> GENERATOR S GER ReAriON I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 281 or title 22 of the CeGfomia code of regulations has been properly <br /> described dassifled and packaged and is in proper condition for transportation a-cording to applicable <br /> regulations AND,it the waste is a treatment residua of s prrAousty restricted hazardous weate <br /> subject to the lead Disposal Restrictions,I certify and warrant that the waste has been treated In Jy !y <br /> accordance with the requirements of 40 CFR Part 288 and is no longer a hazardous waste as defined bRECEIVING FACILITY y Lt__`'+ �-- 1:'" <br /> 40 CFR Part 281 <br /> WASTE TYPE <br /> 0 DISPOSAL ❑SLUDGE <br /> ❑CONSTRUCTION [a WOOD <br /> ❑DEBRIS �IQTHER <br /> ❑SPECIAL WASTE � p <br /> GENERATING FACILITY E <br /> ,E fly <br /> TRANSPORTER T, .,Q- NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> CITY,STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS 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 /> ' � r <br /> REMARKS -41 ❑SOIL r,r �} ti <br /> i ❑CONSTRUCTION <br /> FACILITY TICKET NUM ER ; DEBRIS <br /> ONON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AU ORIz D AGENT. ' J ATE <br /> r ❑WOOD <br /> i r r <br /> a ASH <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 3 00 P M THE DAY PRIORTO EXPECTED ARRIVAL O ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE <br /> MANIFEST# 3 819 5 <br /> GENGRATCIR rOPY <br />