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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island [Forward <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 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 /> GENERATOR : WASTE ACCEPTANCE NO. <br /> Pack G8&Eli•��c <br /> MAILING ADDRESS <br /> 77.Beale Strut,Avail Stop B24A 4 <br /> CITY,STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> F:'�,o.CA 94120 0 GLOVES 0 GOGGLES ❑RESPIRATOR 0 HARD HAT <br /> PHONE <br /> (4'S)973-37,73 0 TY-VEK 0 OTHER <br /> CONTACT PERSON <br /> P(4)atGray SPECIAL HANDLING PROCEDURES: <br /> SIGNATURE OF AUTHORIZED AGENT/TITLE DATE furry <br /> } 5P C- J j <br /> GENERATOR's CERTIFICATION:I hereby MW thatthe above named material is not a hazardous - - - <br /> waste as defined by 40 CFR Part 261 or fitle 22 of the California code of regulations,has been properly - <br /> described,Gasified and packaged,and is in proper condition for transportation a cording to applicable <br /> �`regulatwns,AND,It the waste Is a treatment residue of a previously restricted hazardous waste <br /> subject to the d Disposal Restrictions,I certity and warrant that the waste has boon treated in <br /> torriRECEIVING FACILITY <br /> accorsiance with the requirements of 40 CFR Part 268 and is no longer a hazardous.wasle as defined by <br /> ;,40 CFR Part 261. <br /> VIIASTE TYPE: <br /> 'DI'SPOSAL Q SLUDGE <br /> U CONSTRUCTION O WOOD <br /> LI DEBRIS ❑OTHER <br /> ❑:SPECIAL WASTE <br /> GENERATING FACILITY <br /> 7,7 sy&ak r Station <br /> TRANSPORTER NOTES:. VEHICLE LICENSE NUMBER TRUCK NUMBER. <br /> ( 0 <br /> ADDRESS: <br /> CITY,STATE,ZIP <br /> Wiu&E%i:-A 95,+91 <br /> PHONE. _ END DUMP BOTTOM DUMP TRANSFER <br /> k'707)83&-14Cs __ ❑ ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE . ROLL-OFFS) FLAT-BED VAN DRUMS <br /> ` -('11t C t <br /> N' <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 /> Q SOIL <br /> REMARKS <br /> Q CONSTRUCTION <br /> DEBRIS <br /> FACILITY TICKET NUMBER U NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> Q WOOD <br /> O ASH <br /> U SPECIAL OTHER <br /> N�. <br /> SCHEDULING MUST BE MADE PRIOATO 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# 289886 t0 8 8 C <br /> I V r.J O U <br />