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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward <br /> I 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 Halt 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 /> NON-HAZARDOUS WASTE MANIFEST <br /> GENEPATOR, 13 WASTE ACCEPTANCE NO. <br /> 10AILIV W.RRESS974 <br /> CITY,STATE,ZIP REQUIRED PERSONAL.PROTECTIVE EQUIPMENT <br /> PHONE laGLOVES a GOGGLES 0 RESPIRATOR 0 HARD HAT <br /> -- ❑TY VEK ❑OTHER <br /> CONT CT PE SON SPECIAL HANDLING PROCEDURES <br />' SIGNATURE OF AUTHORIZED AGE TITLE DATE <br /> GENERATMS CER-nFICATfoN l hereby Lenity that the m med mderlMl is not a hazardous <br /> waste as defend by 40 CFR Part 251 or b9s 22 of the Caldomin coda d regubdoM has been Properly <br /> doserlad ctasstfiad and packaged and Is in proper oord k n for tansportatkm aMorram ro applkbble <br /> regula4ons AND,It the waste Is a treabnerd Wields►of a prwbualy rastrictsd hnordoua wash <br /> subled to the tad Disposal RestriMbns i mtuy and warrant that the waste has poen treated kr RECEIVING FACILITY <br /> scwrdmrne with the rer}w menta of 40 CFR Pan 259 and is no kmgar a hazardous waste as defined by <br /> {0 CFR Part 291 <br /> WASTE TYPE <br /> poSgL ❑SLUDGE <br /> ONSTRUCTION ❑WOOD <br /> ❑DEBRIS O OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ADDRESS <br /> IV <br /> CITY,S ATE,41P <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL F S FLAT-BED VAN DRUMS <br /> xvL-a—Z Ll L1 <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 /> I O SOIL <br /> EMARKS <br /> L7 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br />' U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGW DATE <br /> ❑WOOD <br /> H <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P M.THE DAY PRIORTO EXPECTED ARRIVAL a ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> MANIFEsT# 7 Q A Q n <br />