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❑ Keller Canyon ❑ Ox Mountain ❑ Newby IslandForward <br /> 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 94,565 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 /> . GENERATOR kk WASTE ACCEPTANCE NO. <br /> 1',acihc Gas <br /> Ytr. <br /> MAILING ADDRESS J 14- <br /> 77 <br /> Beale. Street Abil Cade B24A <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Son_ranr>jsC a0, _;A y 4105 <br /> PHONE O GLOVES O GOGGLES O RESPIRATOR O HARD HAT <br /> 41j j �— O TY-VEK O OTHER <br /> CONTACT PERSON <br /> Robert Gray SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTH RIZED AGENT/TIT DATE <br /> r <br /> GENERATOR'S CE KATION:I hereby certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properly - <br /> .:described,classified and packaged,and is in proper condition for,transportation a,cordingto applicable- <br /> regulations;AND,It the waste is s Ueatment residue of a previously restricted hazardous waste <br /> subject to the land Disposal ResiriChons;f certify and warrant that the waste has been treated In-: RECEIVING FA I LITY <br /> accordance 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 /> ;Y ISPOSAL U SLUDGE <br /> O CONSTRUCTION_.; U WOOD <br /> U DEBRIS O OTHER <br /> U SPECIAL WAST]=i <br /> GENERATING FACILITY <br /> x NOTES:" VEHICLE LICENSE NUMBER <br /> s TRANS "TER _ ' ' "TRUCK'NUMBER <br /> t <br /> este I rarwWrmoll ADDRESS 0/7 <br /> t< <br /> "env- <br /> PTY,STATE,Z P <br /> W3tidsor ('A 95492 <br /> PHONE �, END DUMP BOTTOM DUMP TRANSFER <br /> r r7)838-1407 ❑ ❑ <br /> SIGN A URE OF AUTHORIZED AGENT O DRIVER DATE ROLE-OFF(S) FLAT-BED VAN DRUMS <br /> ,� -� ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> 1 hereby certify that the above named material has been <br /> accepted arld to the best of my knowledge the foregoing <br /> is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> =' DISPOSE OTHER <br /> U SOIL <br /> EMARKS <br /> O CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER U NON FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> O WOOD <br /> U ASH <br /> U SPECIAL OTHER <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 /> GENERATOR COPY MANIFEST# n n 4 n Al <br />