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❑ Keller Canyon . ❑ Ox Mountain ❑ Newby Island U1 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 /> UCITY, <br /> NERATOR WASTE ACCEPTANCE NO. <br /> `,-&-.Gas&Fle--f c <br /> 431-4 <br /> LING ADDRESS <br /> Fs Stxi'l , al Stc �4. <br /> STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> Sm FrawciswCA 94120 U GLOVES ❑GOGGLES U RESPIRATOR U HARD HAT <br /> PHONE <br /> (415')9i -3713 U TY-VEK U OTHER <br /> CONTACT PERSON SPECIAL HANDLING PROCEDURES: <br /> Robert Gray' L w <br /> SIGNATURE OF AUTHORIZR AGENT/TITLE DATE <br /> ' GENERATOR'S CERTIFICATION:I hereby.=I the above named material is not a.hazardous <br /> a` waste as defined by 40 CFR Part 261or title 22 of the California code of regulations,has been property <br /> described,classified and packaged,and is in proper condition for transportation a-cording to applicable '. <br /> -. regulations,AND,It the waste Is a treatment residue of a previously restricted hazardous waste <br /> .. subject to the Land Disposal.Restrictions,I certify and warrant that the waste has been treated in <br /> RECEIVING FACILITY <br /> accordann��ee withthe requirements of 40 CFR Pail and is no longer a hazardous waste as defined by <br /> �40CFR Par1261.. <br /> ASTE TYPE: <br /> ISPOSAL U SLUDGE <br /> CONSTRUCTION O WOOD <br /> DEBRIS" O OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> L Oehyd V;,-r S aikm i;t T-RO <br /> TRANSPORTER " NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> ':Iyer a'i: <br /> ' <br /> ADDRESS <br /> ITS}_T' �s e CourtCITY, STATE,ZIP <br /> PHONE END DUMP BOTTOM DUMP TRANSFER <br /> f707)0338-1407 - ❑ ❑ <br /> SIGNATURE OFA0T ORIZED AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN DRUMS <br /> CUBIC YARDS` <br /> 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 /> DEBRIS <br /> FACILITY TICKET NUMBER o 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.# 2 (j Q Q <br />