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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island aForward <br />' Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Batloy Load - 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 /> • NON-HAZARDOUS WASTE MANIFEST <br />' GENE TORWASTE ACCEPTANCE N0. <br /> MAILING ADDRESS — 3 Z <br />' S` <br /> CITY,ST TE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> G ❑GLOVES ❑GOGGLES ©RESPtRATOR ❑HARD HAT <br />' PHONE <br /> 3 7 ❑TY VEK ❑OTHER <br /> CONTA T PERSON SPECIAL HANDLING PROCEDURES <br />' SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br />' GENERATOR'S CERTIFICATION I hereby rvy that the above named materiel is not a hszardow <br /> waste as deerad by 40 CFR Part 261 or We 22 of the CaMomle code d rapudatlons hes been properly <br /> described dsssdied and padcayed.esrd is in proper condtllon for Ua►wportaHon amordirrg tD Opplicabie <br /> mgulawm Alm N the woos is a ksat ram real hm of a prevfoury restricted hezerdoua cresta <br /> subject to the land ohposak Resuk ons.i eemy and warram mat ms waste has bee"treated rn RECEIVING FACILITY <br />' acoordanco wrm me requkaments of 40 CFR Part 266 and Is no longer a hazardous waste as detlned by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> ISPOSAL Q SLUDGE <br /> •CONSTRUCTION ❑WOOD <br />' Q DEBRIS ❑OTHER <br /> ©SPECIAL WASTE <br /> GENERATING' FACILITY/f AlmTCISjpj 7 O v C.L— S <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER MYCK NUMBER <br /> 1 ADDRESS <br /> 2� <br /> CITY,STATE,ZIP <br />' 2 <br /> PHONE EN UMP BOTTOM DUMP TRANSFER <br /> - <br /> 9IG—NATUAE OF AUTHORIZED AGENT OR DRIVER DATE ROLL S FLAT-BED VAN DRUMS <br />' ALI ❑ LI ❑ <br /> L <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 />' ❑SOIL <br /> EMARKS <br /> ❑caNsraucTloN <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br />' ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE U WOOD <br />' ❑ASI-I <br /> ❑SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIORTO 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 /> t wut�tesr t rntev <br /> MANIFEST i 28969 <br />