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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island Forward <br /> ISanitary 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 Milp tas,CA 95035 Manteca,CA 95336 <br /> PR,one(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 /> GE ERAT R WASTE ACCEPTANCE NO. <br /> 6f— <br /> MAILING ADDRESS _ F 3",� <br /> CITY,S ATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> C' a 7-- ❑GLOVES U GOGGLES ❑RESPIRATOR ❑HARD HAT <br />' PHONE <br /> ❑TY VEK O OTHER <br /> CONT CTP SON SPECIAL.HANDLING PROCEDURES <br />' SI NATURE OF AUTHORIZE GENT/TITLE DATE <br />' GENERATOR'S CERTIFICATION I herebY ou"turt the abowa named materiel Is not a hazardous <br /> waste as defined by 40 CFR Part 281 or bile 22 of the CaRfornm code of regulations has been properly <br /> descrfl d cl3aaf8ed and packaged.and is In proper cordltron for transportation wimcc nq to eppecable <br /> s�4r lheAN% Disposal fl is a residua�Iprew lady wash be d hazardous tat to waste has been treated iwaab <br /> accordance with the regrnrarnents of 40 CFR Part 268 and is no longer a hazardous waste as defined by RECEIVING FACILITY <br />' 40 CFR Part tel <br /> W T TYPE <br /> DISPOSAL ❑SLUDGE <br />' NSTRUCTION ❑WOOD <br /> ❑DEBRIS 0 OTHER <br /> ❑SPECIAL WASTE <br /> GENERATING FACILITY <br /> s <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> T�_ <br />' ADDRESS <br /> S 211 <br /> D <br /> CITY,STATE,ZIP <br />' 6 <br /> PHONE END MP BOTTOM DUMP TRANSFER <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER !DATE ROLL F S FLAT-BED VAN DRUMS <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 />' O SOIL <br /> REMARKS <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER O DEBRIS <br /> NON-FRIABLE <br />' ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE/!)/ O WOOD <br /> r�1N ASH <br /> O PECIAL OTHER <br />' <br /> SCHEDULING MUST BE MADE PRIORT03.00 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 <br />