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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,CA94565 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 /> r� <br /> } GENERATOR <br /> Gas�Electric WASTE ACCEPTANCE NO. <br /> MAIL{IINGA�D,D�RE��Sf/S B24 <br /> p <br /> 4314 <br /> { ' CITY STATE;ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> t` tA-CA.�341 Q GLOVES 0 GOGGLES Q RESPIRATOR Q HARD HAT <br /> t?HONE <br /> :c,015)97,3-3773 0 TY-VEK 0 OTHER <br /> r� CON ACT PERSON Robzrt CirRV SPECIAL HANDLING PROCEDURES: <br /> ,rx :SIGNATURE OF AUTHORIZED AGENT/TITLE DATE <br /> Y'F <br /> GENERATOR'S CERTIFICATION:I hereby certify that a named material is not a hazardous <br /> ,wade as de fined by 40 CFR Part 261 or:title 22 of Bre California code of regulations,has been propertybl - <br /> ridescribed,classified and packaged,and is in proper condition for transportation a-cording to applicae <br /> e .regulations;AN D,,tf the waste is a treatment realdue o/a prevlousty rest6ded hazardous waste <br /> Subject to the Land.Disposal Restrictions,I certify and warrant that the waste has been treated m RECEIVING FACILITY <br /> 3;,accadance wdh the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFRPart 261_ <br /> ASTE.TYPE: <br /> 3 ISPOSAL ❑SLUDGE <br /> CONSTRUCTION Q WOOD <br /> D DEBRIS O OTHER <br /> SPEGALWASTE <br /> ENEI3ATING FACILITY <br /> I�y&aio Staditm LAT,yi1lOP <br /> CRA P �tTER' NOTES. `VEHICLE LICENSE:N "fiR K':f UN113ER <br /> ADDRESS �i✓' <br /> DenBeee Court <br /> LTY,STATE,ZIP <br /> 441 <br /> ?HONE END DUMP BOTTOM DUMP TRANSFE <br /> Tt17)838-1497 ❑ <br /> SIGNATURE OF AUTHORIZED AGENT OR DRIVER DATE ROLL-OFFS) FLAT-BED VAN DRUMS <br /> 1 ❑ ❑ ❑ ❑ <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 <br /> is true and accurate. DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> DISPOSE OTHER <br /> EMARKS ❑SOIL <br /> Q CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENT DATE ASBESTOS <br /> Q WOOD <br /> ❑ASH <br /> Q 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 /> C,FNFP.ATnR CC)PY MANIFEST# n n n r%n-i <br />